Erythrodermic psoriasis and palmoplantar hyperkeratosis successfully treated with secukinumab: a case report

Authors

  • Martino Carriero Dermatology Unit

DOI:

https://doi.org/10.33393/dti.2022.2355

Keywords:

Biologic therapy, Erythrodermic psoriasis, Interleukin-17, Monoclonal antibody, Palmoplantar hyperkeratosis, Secukinumab

Abstract

Erythrodermic psoriasis (EP) is a rare and severe form of psoriasis that affects 1 to 2.25% of patients, increasing mortality risk. To date, very few therapies have been approved for the treatment of this condition. Recently, biological therapies which specifically target inflammatory cytokines have improved the management and treatment of EP. Secukinumab, a human monoclonal antibody that specifically targets interleukin-17A (IL-17A), has been shown to be beneficial in different psoriasis settings. We report the case of a 72-year-old man affected by persistent EP and severe palmoplantar hyperkeratosis whose condition was not resolved after two rounds of treatment with prednisone and therapy with cyclosporine. Treatment with secukinumab significantly improved the symptoms of palmoplantar hyperkeratosis as early as the first weeks, with a decrease of Psoriasis Area Severity Index (PASI) score from 60 to 10, showing almost complete remission after 1 month. Consistent with the current literature, secukinumab treatment showed promising and encouraging clinical outcomes in the treatment of the patient’s EP. However, more studies are needed to clarify the IL-17-dependent mechanism in the pathophysiology of EP.

References

  1. Rajguru JP, Maya D, Kumar D, Suri P, Bhardwaj S, Patel ND. Update on psoriasis: A review. J Family Med Prim Care. 2020;9(1):20-24. https://doi.org/10.4103/jfmpc.jfmpc_689_19PMID:32110559 DOI: https://doi.org/10.4103/jfmpc.jfmpc_689_19
  2. Deng Y, Chang C, Lu Q. The Inflammatory Response in Psoriasis: a Comprehensive Review. Clin Rev Allergy Immunol. 2016;50(3):377-389. https://doi.org/10.1007/s12016-016-8535-xPMID:27025861 DOI: https://doi.org/10.1007/s12016-016-8535-x
  3. Armstrong AW, Read C. Pathophysiology, Clinical Presentation, and Treatment of Psoriasis: A Review. JAMA. 2020;323(19):1945-1960. https://doi.org/10.1001/jama.2020.4006PMID:32427307 DOI: https://doi.org/10.1001/jama.2020.4006
  4. Reynolds KA, Pithadia DJ, Lee EB, Liao W, Wu JJ. A systematic review of treatment strategies for erythrodermic psoriasis. J Dermatolog Treat. 2021;32(1):49-55. https://doi.org/10.1080/09546634.2019.1689228 PMID:31682547 DOI: https://doi.org/10.1080/09546634.2019.1689228
  5. Carrasquillo OY, Pabón-Cartagena G, Falto-Aizpurua LA, et al. Treatment of erythrodermic psoriasis with biologics: A systematic review. J Am Acad Dermatol. 2020;83(1):151-158. https://doi.org/10.1016/j.jaad.2020.03.073 PMID:32247872 DOI: https://doi.org/10.1016/j.jaad.2020.03.073
  6. Singh RK, Lee KM, Ucmak D, et al. Erythrodermic psoriasis: pathophysiology and current treatment perspectives. Psoriasis (Auckl). 2016;6:93-104. https://doi.org/10.2147/PTT.S101232PMID:28856115 DOI: https://doi.org/10.2147/PTT.S101232
  7. Fitch E, Harper E, Skorcheva I, Kurtz SE, Blauvelt A. Pathophysiology of psoriasis: recent advances on IL-23 and Th17 cytokines. Curr Rheumatol Rep. 2007;9(6):461-467. https://doi.org/10.1007/s11926-007-0075-1 PMID:18177599 DOI: https://doi.org/10.1007/s11926-007-0075-1
  8. Berg SH, Balogh EA, Ghamrawi RI, Feldman SR. A review of secukinumab in psoriasis treatment. Immunotherapy. 2021;13(3):201-216. https://doi.org/10.2217/imt-2020-0195PMID:33203276 DOI: https://doi.org/10.2217/imt-2020-0195
  9. Chiricozzi A, Krueger JG. IL-17 targeted therapies for psoriasis. Expert Opin Investig Drugs. 2013;22(8):993-1005. https://doi.org/10.1517/13543784.2013.806483 PMID:23731078 DOI: https://doi.org/10.1517/13543784.2013.806483
  10. Wasilewska A, Winiarska M, Olszewska M, Rudnicka L. Interleukin-17 inhibitors. A new era in treatment of psoriasis and other skin diseases. Postepy Dermatol Alergol. 2016;33(4):247-252. https://doi.org/10.5114/ada.2016.61599 PMID:27605893 DOI: https://doi.org/10.5114/ada.2016.61599
  11. Reich K, Warren RB, Coates LC, Di Comite G. Long-term efficacy and safety of secukinumab in the treatment of the multiple manifestations of psoriatic disease. J Eur Acad Dermatol Venereol. 2020;34(6):1161-1173. https://doi.org/10.1111/jdv.16124 PMID:31785165 DOI: https://doi.org/10.1111/jdv.16124
  12. Deodhar A, Mease PJ, McInnes IB, et al. Long-term safety of secukinumab in patients with moderate-to-severe plaque psoriasis, psoriatic arthritis, and ankylosing spondylitis: integrated pooled clinical trial and post-marketing surveillance data. Arthritis Res Ther. 2019;21(1):111. https://doi.org/10.1186/s13075-019-1882-2 DOI: https://doi.org/10.1186/s13075-019-1882-2
  13. Baraliakos X, Gossec L, Pournara E, et al. Secukinumab in patients with psoriatic arthritis and axial manifestations: results from the double-blind, randomised, phase 3 MAXIMISE trial. Ann Rheum Dis. 2021;80(5):582-590. https://doi.org/10.1136/annrheumdis-2020-218808PMID:33334727 DOI: https://doi.org/10.1136/annrheumdis-2020-218808
  14. Kiltz U, Sfikakis PP, Gaffney K, et al. Secukinumab Use in Patients with Moderate to Severe Psoriasis, Psoriatic Arthritis and Ankylosing Spondylitis in Real-World Setting in Europe: Baseline Data from SERENA Study. Adv Ther. 2020;37(6):2865-2883. https://doi.org/10.1007/s12325-020-01352-8 PMID:32378070 DOI: https://doi.org/10.1007/s12325-020-01352-8
  15. Cosentx-Summary Of Product Characteristics. Available at: https://www.ema.europa.eu/en/documents/product-information/cosentyx-epar-product-information_en.pdf (Accessed October 2021)
  16. Frieder J, Kivelevitch D, Menter A. Secukinumab: a review of the anti-IL-17A biologic for the treatment of psoriasis. Ther Adv Chronic Dis. 2018;9(1):5-21. https://doi.org/10.1177/2040622317738910 PMID:29344327 DOI: https://doi.org/10.1177/2040622317738910
  17. Langley RG, Elewski BE, Lebwohl M, et al; ERASURE Study Group; FIXTURE Study Group. Secukinumab in plaque psoriasis--results of two phase 3 trials. N Engl J Med. 2014;371(4):326-338. https://doi.org/10.1056/NEJMoa1314258 PMID:25007392 DOI: https://doi.org/10.1056/NEJMoa1314258
  18. Damiani G, Pacifico A, Russo F, et al. Use of Secukinumab in a Cohort of Erythrodermic Psoriatic Patients: A Pilot Study. J Clin Med. 2019;8(6):770. https://doi.org/10.3390/jcm8060770PMID:31159169 DOI: https://doi.org/10.3390/jcm8060770
  19. Weng HJ, Wang TS, Tsai TF. Clinical experience of secukinumab in the treatment of erythrodermic psoriasis: a case series. Br J Dermatol. 2018;178(6):1439-1440. https://doi.org/10.1111/bjd.16252 PMID:29265175 DOI: https://doi.org/10.1111/bjd.16252