Immunological changes in psoriasis patients under long-term treatment with fumaric acid esters: risk of Kaposi sarcoma occurrence?

Abstract

BACKGROUND:

Psoriasis is a chronic skin disorder. The most frequently used systemic anti-psoriatic therapy in Germany is fumaric acid esters (FAE).

OBJECTIVES:

We aimed to characterize immunological changes in psoriasis patients under FAE treatment.

METHODS AND MATERIALS:

Over 200 flow-cytometry analyses of blood from 27 psoriasis patients and histological, molecular, and serological analyses of samples from a patient who developed Kaposi sarcoma (KS) during FAE therapy were performed.

RESULTS:

The patients receiving FAE showed decreased CD8+ T cell counts, in particular during the first six months. The CD4+ T cell decline was less pronounced and delayed in time. In a patient with KS, we found a profound CD4 and CD8 lymphocytopenia, as well as a NK cell number reduction, although leukocyte and lymphocyte counts were within the recommended limits. The patient was HIV negative, but positive for HHV8. After cessation of FAE therapy, KS regressed.

DISCUSSION:

HHV8 infection and iatrogenic T cell reduction, prominently of CD8+ T cells, could have contributed to KS development in this patient. Therefore, we suggest a control of CD4+ and CD8+ T cell counts in addition to the commonly-used differential blood counts in patients with a higher HHV8 prevalence or at high risk of other latent viral infections.

• Authors: Sandra Philipp, Georgios Kokolakis, Martina Hund, Ellen Witte, Katrin Witte, Stefanie Kunz, Hans Joachim Roewert, Wolfram Sterry, Robert Sabat
• Journal: European journal of dermatology : EJD (Eur J Dermatol) 2013 May-Jun Vol. 23 Issue 3 Pg. 339-43 ISSN: 1952-4013 [Electronic] France
• PMID: 23774790 (Publication Type: Case Reports, Journal Article)

Chemical References

• Fumarates

Topics

• Fumarates (therapeutic use)
• Herpesvirus 8, Human
• Humans
• Male
• Middle Aged
• Psoriasis (drug therapy, immunology)
• Risk Factors
• Sarcoma, Kaposi (etiology, virology)
• Skin Neoplasms (etiology, virology)
• Time Factors