Skin manifestations of SAPHO syndrome

Abstract

Synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome is a rare disease with chronic inflammatory osteoarticular symptoms and various dermatologic lesions, manifesting as synovitis, acne, pustulosis, hyperostosis and osteitis. Various skin manifestations of SAPHO syndrome mainly include palmoplantar pustulosis, severe acne, psoriasis vulgaris and follicular occlusion triad. However, the causes of skin manifestations of SAPHO syndrome remain uncertain. Recent studies have found that it may be related to the activation of Toll-like receptor 2 (TLR-2) pathway and dysregulation of P2X7-interleukin (IL) -1β axis. It is hard to control the symptoms of SAHPO syndrome. Non-steroidal anti-inflammatory drugs (NSAIDs) usually serve as traditional first-line drugs, and second-line drugs usually include glucocorticoids, bisphosphonates and antirheumatic drugs. Current studies also suggest that tumor necrosis factor-α (TNF-α) antagonists can relieve the symptoms of SAPHO syndrome, but their therapeutic effect is also controversial. Recent studies have found that secukinumab, an IL-17A antagonist, is rather effective for palmoplantar pustulosis. Correct understanding of the skin manifestations is meaningful for early diagnosis, treatment and pathological exploration of SAPHO syndrome. Key words: Acquired hyperostosis syndrome; Skin manifestations; Psoriasis; Acne vulgaris; Hyperostosis