Paradoxical Psoriasis: An Updated Review of Clinical Features, Pathogenesis, and Treatment Options

J Invest Dermatol. 2024 Jul 2:S0022-202X(24)01731-7. doi: 10.1016/j.jid.2024.05.015. Online ahead of print.

ABSTRACT

The definition of paradoxical psoriasis (PP) encompasses 2 main scenarios, namely, (i) new-onset psoriasis in patients treated for a different disease and (ii) worsening as well as phenotypical change of pre-existing psoriasis. Originally restricted to the appearance of an untoward psoriasiform reaction under TNF inhibitors, the term has gained new meaning, with the progressive observation of psoriasis-like eruptions also with other medications. Although the conceptual framework of PP has expanded, a molecular and clinicotherapeutic classification is still lacking. In addition, a certain degree of confusion surrounds the correct terminology to indicate these eruptions. In this paper, evidence on the epidemiology, clinical features, pathogenesis, and treatment of PP is reviewed, providing a perspective on possible pathogenesis-driven therapeutic approaches.

PMID:38958610 | DOI:10.1016/j.jid.2024.05.015