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Correspondence to Author: Yan Lu, 

Department of Dermatology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, PR China.

Abstract:

Common chronic skin disease psoriasis is primarily caused by the intricate interaction of T cells, dendritic cells, and inflammatory cytokines such as TNF-α, IL-17, IL-12, and IL-23. The significance of these important cytokines, particularly TNF-α, has been demonstrated by successful anti-cytokine antibody therapy. A tiny percentage of patients experience the development of new psoriasiform lesions while receiving anti-TNF-α medication for classical idiopathic psoriasis. This contradictory condition, known as paradoxical psoriasis, has separate immunological processes and overlapped histology patterns, hence clinically resembling idiopathic psoriasis. We go over the distinctions between idiopathic and paradoxical psoriasis in this review, focusing primarily on innate immunity since paradoxical psoriasis is characterized by type I IFN-mediated immunity without the activation of memory and autoreactive T cells. Additionally, we posted a useful algorithm for the treatment of paradoxical psoriasis. The severity of lesions and the state of underlying disorders should be taken into consideration when deciding whether to switch biologics or stop taking a medication.

Keywords : :  Paradoxical psoriasis, Tumor necrosis factor inhibitors, biological products,immunity, innate

INTRODUCTION :
In people who are genetically susceptible, psoriasis is a common chronic inflammatory skin disease that is mostly brought on by the interaction of multiple environmental risk factors. One of the main contributing factors is persistent inflammation.
harmful function. Its global prevalence is from 2% to 3%, with a small predilection for adults over children and a similar prevalence in both genders [1]. Extrinsic risk factors for psoriasis include infections, mechanical stress, air pollution, vaccinations, smoking, alcohol, and smoking [4–6]. Significant intrinsic risk factors include mental stress, obesity, diabetes mellitus, metabolic syndrome, and hypertension. The clinical variations of idiopathic psoriasis include pustular, erythrodermic, guttate, plaque, and inverse psoriasis, based on morphologic characteristics. The most common form of plaque psoriasis is characterized by erythematous, scaly patches or plaques over the body, scalp, and surface extensor muscles. According to histopathology, it is characterized by prominent epidermal acanthosis, hyperkeratosis, parakeratosis, and rete ridge extension. It also shows persistent inflammatory infiltration, primarily of T cells, neutrophils, macrophages, and mast cells in the skin’s outer layer

Citation:

Yan Lu. Is a reversible autocephalous medication reaction or is paradoxical psoriasis the opposite of idiopathic psoriasis?. The Journal of Autoimmunity 2024.