Erythrodermic Psoriasis Improved by Ustekinumab: A Report ...Erythrodermic Psoriasis Improved by Ustekinumab: A Report of Two Cases Ye Seul Kim, Hyun Ju Kim, Sanghoon Lee, Young Lip

Letter to the Editor

Vol. 28, No. 1, 2016 121

Received January 2, 2015, Revised March 5, 2015, Accepted for publication March 21, 2015

Corresponding author: Young Lip Park, Department of Dermatology, Soonchunhyang University Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon 14584, Korea. Tel: 82-32-621-5062, Fax: 82-32-621-5560, E-mail: [email protected]

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, pro-vided the original work is properly cited.

http://dx.doi.org/10.5021/ad.2016.28.1.121

Erythrodermic Psoriasis Improved by Ustekinumab: A Report of Two Cases

Ye Seul Kim, Hyun Ju Kim, Sanghoon Lee, Young Lip Park

Department of Dermatology, Soonchunhyang University College of Medicine, Bucheon, Korea

Dear Editor:Erythrodermic psoriasis is a severe form of psoriasis, pre-senting as prominent erythema rather than thick scales, af-fecting the entirebody including the face, trunk, extremities, and nails. The disease poses a therapeutic challenge, and numerous treatment choices have been examined1. Ustekinumab (Stelara; Jannssen Biotech Inc., Horsham, PA, USA) is a human monoclonal antibody targeting the p40 subunit shared by interleukin (IL)-12 and IL-23. This biological agent has shown good efficacy against pla-que-type psoriasis and emerging effectiveness in a variety of inflammatory skin diseases such as atopic dermatitis2. Erythrodermic psoriasis has been an exclusion criterion in studies evaluating the efficacy of ustekinumab for psor-iasis, but recently, a few reports have proven its efficacy in treating erythrodermic psoriasis3-5. Herein, we report 2 cases of erythrodermic psoriasis that successfully im-proved following ustekinumab treatment.A 42-year-old man presented with a 7-year history of er-ythrodermic psoriasis and a 5-year history of psoriatic arthritis. He was previously treated with cyclosporine A, methotrexate, and narrow band ultraviolet B photo-therapy. The treatments were interrupted due to liver en-zyme elevation and low efficacy. The patient was treated with ustekinumab 45 mg subcutaneously at 0, week 4, and every 12 weeks thereafter. The patient was also diag-nosed with latent pulmonary tuberculosis by the QuantiFERON-TB Gold In-Tube test (Cellestis Limited, Carnegie, VIC, Australia). He was concurrently treated with isoniazid 300 mg/day for 6 months and has not expe-rienced a recurrence of tuberculosis to date. At week 28,

his Psoriasis Area and Severity Index (PASI) score de-creased from 64.8 (baseline) to 9.6 (Fig. 1). The psoriasis aggravated temporarily during discontinuation of the treat-ment for 5 months and he promptly recovered upon re-starting ustekinumab injections. His arthritis symptoms im-proved slightly, but the improvement was not sufficient for him to stop taking oral sulfasalazine and steroid for the arthralgia.The second case is a 26-year-old man suffering from eryth-rodermic psoriasis for 10 years. Therapies with conven-tional systemic agents and anti-tumornecrosis factor were discontinued due to lack of efficacy. Four months after the first administration of ustekinumab (45 mg), the patient achieved 75% improvement of the PASI score from 50.9 (baseline) to 4.4 (Fig. 2A, B). Currently, the patient has re-ceived treatment for 112 weeks, and is maintaining a PASI 90 improvement (Fig. 2C).Both patients are currently on treatment, and show sus-tained responses without any adverse reactions or exa-cerbations. Although further studies are needed to eval-uate the efficacy and safety of ustekinumab, it is likely that ustekinumab can be an effective therapeutic option for pa-tients affected by erythrodermic psoriasis where other treatments have failed.

ACKNOWLEDGMENT

This work was supported in part by the Soonchunhyang University Research Fund.

Letter to the Editor

122 Ann Dermatol

Fig. 1. A 42-year-old man presented with whole body erythema with scanty scales. He responded well to ustekinumab (A: baseline, B: 28 weeks after the treatment, C: 76 weeks after the treatment).

Fig. 2. A 26-year-old man. (A) Baseline: normal skin islands are noticeable within the diffuse erythroderma. Clinical improvement was significant and sustained (B) 28 weeks after the treatment and (C) 112 weeks after the treatment, respectively.

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