Akne-Triade als paradoxe Reaktion auf Therapie mit dem IL-6-Inhibitor Tocilizumab

Zusammenfassung

Als Akne-Triade bezeichnet man eine Kombination aus Acne conglobata und intertriginöser Akne axillär (sog. Hidradenitis suppurativa) und inguinal/genitoanal. Eine Perifolliculitis capitis abscedens et suffodiens und/oder Steißbeinfisteln (Akne-Tetrade) können hinzutreten. Es handelt sich dabei um eine schwere, chronisch-rezidivierende, furunkuloide und hochentzündliche Form der Akne mit Haut und Subkutis betreffender abszedierender, fistelnder und vernarbender Entzündung, ausgehend von der Haarbalg-Talgdrüsen-Einheit. Das Biologikum Tocilizumab (Handelsnamen RoActemra^®) ist ein humanisierter, monoklonaler Antikörper gegen den Interleukin-6 (IL-6)-Rezeptor zur Behandlung der rheumatoiden Arthritis (RA) und der schwersten Form des kindlichen Rheumas, der systemischen juvenilen idiopathischen Arthritis (sJIA; Syn. Morbus Still). Interleukin-6 ist ein Zytokin, das im menschlichen Körper Entzündungsreaktionen moduliert. Hier beschreiben wir den Fall eines 17-jährigen Patienten, der unter der Therapie mit Tocilizumab die schwerste Form einer Akne-Triade als paradoxe Reaktion entwickelte.

Abstract

The term acne triade refers to a combination of acne conglobata, axillar and inguinal/genitoanal intertriginous acne (hidradenitis suppurativa). Perifolliculitis capitis abscedens et suffodiens and/or sacral fistulation may occur additionally (acne tetrad). This contains a highly inflammatory, chronic-recurrent, furunculoid form of acne involving the skin and subcutis with abscesses, fistulation and scaring evolving from hair-follicle inflammation. The biological Tocilizumab (trade name RoActemra^®) is a humanized monoclonal antibody to the interleukin-6 (IL-6)-receptor for the treatment of rheumatoid arthritis (RA) and the most severe form of childhood rheumatism, systemic juvenile idiopathic arthritis (sJIA; Syn. Still’s disease). Interleukin-6 is a cytokine that modulates inflammatory reactions in the human body. Here we describe the case of a 17-year-old patient who developed under treatment with tocilizumab severe form of acne triad as a paradoxical reaction under this therapy.

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