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Prolongierte Psoriasistherapie mit TNF-α-Antagonisten

Entwicklung des malignen Melanoms

Long term treatment of psoriasis with TNF-alpha antagonists

Occurrence of malignant melanoma

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Zusammenfassung

Wir berichten über einen 51-jährigen Patienten, der de novo ein kutanes malignes Melanom (Stadium Ia) am Ende einer insgesamt 30-monatigen Behandlung mit TNF-α-Antagonisten entwickelte. Wegen einer therapierefraktären mittelschweren Plaquepsoriasis, erhielt er nacheinander Infliximab, Adalimumab und zuletzt Etanercept. Vorher war der Patient über einen Zeitraum von 4 Jahren mit Fumaraten, für 2 Monate mit Cyclosporin A und für 5 Wochen mit Methotrexat behandelt worden. Vor bzw. zwischen den systemischen Medikamentenbehandlungen waren 2 Serien mit Creme-PUVA bzw. UVB appliziert worden. Der mögliche Zusammenhang zwischen der Entstehung eines malignen Melanoms und der immunsuppressiven Therapie wird anhand der aktuellen Literatur diskutiert. Der Abbruch einer Therapie mit TNF-α-Antagonisten nach Auftreten eines Melanoms wird empfohlen.

Abstract

A 51-year-old white man developed de novo a cutaneous malignant melanoma (Stage Ia) after a 30-month treatment period with TNF-alpha-antagonists, consecutively using infliximab, adalimumab and etanercept because of a recalcitrant moderate to severe plaque psoriasis. The patient previously had been treated fumarates for 4 years, cyclosporine A for 2 months and methotrexate for 5 weeks. He also received cycles of cream PUVA and UVB before and then between systemic medications. A possible causal connection between development of melanoma and immunosuppressive treatment is discussed in the light of recent literature. The termination of TNF-alpha-antagonist therapy following development of melanoma is recommended.

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Danksagung

Wir danken Herrn Dr. med. Christoph Seidl, Pathologische Gemeinschaftspraxis Dres. med. Sachs, Kribus und Seidl in Hof, für die histologischen und immunhistologischen Untersuchungen.

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Authors and Affiliations

  1. Klinik für Hautkrankheiten und Allergologie, HELIOS Vogtland-Klinikum Plauen GmbH, 100153, 08505, Plauen, Deutschland

    L. Kowalzick, L. Eickenscheidt & M. Komar

  2. Medizinsches Versorgungszentrum, HELIOS Vogtland-Klinikum Plauen GmbH, Plauen, Deutschland

    E. Schaarschmidt

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  1. L. Kowalzick
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  2. L. Eickenscheidt
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  3. M. Komar
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  4. E. Schaarschmidt
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Correspondence to L. Kowalzick.

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Kowalzick, L., Eickenscheidt, L., Komar, M. et al. Prolongierte Psoriasistherapie mit TNF-α-Antagonisten. Hautarzt 60, 655–657 (2009). https://doi.org/10.1007/s00105-008-1695-8

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  • DOI: https://doi.org/10.1007/s00105-008-1695-8

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