Anakinra for difficult-to-treat neutrophilic panniculitis: IL-1 blockade as a promising treatment option for neutrophil-mediated inflammatory skin disease.
The treatment of neutrophilic panniculitis can be challenging. We report a patient with a difficult-to-treat neutrophilic panniculitis who had a spectacular response to a short treatment course with the IL-1 antagonist anakinra. A 61-year-woman had a 12-year history of a serious febrile neutrophilic panniculitis and a personal history of steroid-induced pancreatitis and life-threatening methemoglobinemia under antimalarials and dapsone. When she developed a new flare, she was treated successfully with a 15-day course of subcutaneously administered injections of 100 mg anakinra. This observation is the first report attesting the efficiency of anakinra in neutrophilic panniculitis. It expands the potential indications of IL-1 inhibition in the field of the neutrophilic dermatoses, or more generally, in neutrophil-mediated systemic diseases. It underscores the potential pathogenic involvement of IL-1 in those diseases, a hallmark of autoinflammation, and supports their nosologic classification among diseases involving primarily the innate immune system.
Lipsker
Dan
D
Université de Strasbourg, Faculté de Médecine et Clinique Dermatologique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France. dlipsker @ gmail.com
Perrigouard
Cécile
C
Foubert
Audrey
A
Cribier
Bernard
B
D003622:Dapsone / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005334:Fever / Q000188:drug therapy; D006801:Humans; D053590:Interleukin 1 Receptor Antagonist Protein / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D009504:Neutrophils; D015434:Panniculitis / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D017472:Receptors, Interleukin-1 / Q000037:antagonists & inhibitors*; D016896:Treatment Outcome
D053590:Interleukin 1 Receptor Antagonist Protein; D017472:Receptors, Interleukin-1; D003622:Dapsone