Eruptive papules during efalizumab (anti-CD11a) therapy of psoriasis vulgaris: A case series

Michelle A. Lowes, Francesca Chamian, Maria V. Abello, Craig Leonardi, Wolfgang Dummer, Kim Papp, James G. Krueger

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Newer biological therapies for moderate-to-severe psoriasis are being used more frequently, but unexpected effects may occur. Case presentations: We present a group of 15 patients who developed inflammatory papules while on efalizumab therapy (Raptiva, Genentech Inc, anti-CD11a). Immunohistochemistry showed that there were increased CD11b+, CD11c+ and iNOS+ cells (myeloid leukocytes) in the papules, with relatively few CD3++ T cells. While efalizumab caused a decreased expression of CD11a on T cells, other circulating leukocytes from patients receiving this therapy often showed increased CD11b and CD11c. In the setting of an additional stimulus such as skin trauma, this may predispose to increased trafficking into the skin using these alternative β2 integrins. In addition, there may be impaired immune synapse formation, limiting the development of these lesions to small papules. There is little evidence for these papular lesions being "allergic" in nature as there are few eosinophils on biopsy, and they respond to minimal or no therapy even if efalizumab is continued. Conclusion: We hypothesize that these papules may represent a unique type of "mechanistic" inflammatory reaction, seen only in the context of drug-induced CD11a blockade, and not during the natural disease process.

Original languageEnglish (US)
Article number2
JournalBMC Dermatology
Volume7
DOIs
StatePublished - Feb 26 2007
Externally publishedYes

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Psoriasis
Leukocytes
T-Lymphocytes
Skin
Biological Therapy
Myeloid Cells
Therapeutics
Eosinophils
Integrins
Synapses
Immunohistochemistry
Biopsy
efalizumab
Wounds and Injuries
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Dermatology

Cite this

Lowes, M. A., Chamian, F., Abello, M. V., Leonardi, C., Dummer, W., Papp, K., & Krueger, J. G. (2007). Eruptive papules during efalizumab (anti-CD11a) therapy of psoriasis vulgaris: A case series. BMC Dermatology, 7, [2]. https://doi.org/10.1186/1471-5945-7-2

Eruptive papules during efalizumab (anti-CD11a) therapy of psoriasis vulgaris : A case series. / Lowes, Michelle A.; Chamian, Francesca; Abello, Maria V.; Leonardi, Craig; Dummer, Wolfgang; Papp, Kim; Krueger, James G.

In: BMC Dermatology, Vol. 7, 2, 26.02.2007.

Research output: Contribution to journalArticle

Lowes, MA, Chamian, F, Abello, MV, Leonardi, C, Dummer, W, Papp, K & Krueger, JG 2007, 'Eruptive papules during efalizumab (anti-CD11a) therapy of psoriasis vulgaris: A case series', BMC Dermatology, vol. 7, 2. https://doi.org/10.1186/1471-5945-7-2
Lowes, Michelle A. ; Chamian, Francesca ; Abello, Maria V. ; Leonardi, Craig ; Dummer, Wolfgang ; Papp, Kim ; Krueger, James G. / Eruptive papules during efalizumab (anti-CD11a) therapy of psoriasis vulgaris : A case series. In: BMC Dermatology. 2007 ; Vol. 7.
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