Anti IL-17 flared psoriasis in a patient on secukinumab

Secukinumab-induced paradoxical pustular psoriasis

“…IL‐12 and IL‐23 mediate two principal pathogenetic pathways of psoriasis. Noell and colleagues hypothesized that blockade of IL‐17A by secukinumab might cause compensatory overproduction of the cytokines earlier in this pathway (IL‐23, IL‐17F) or those belonging to the other arm (IL‐12, TNF‐α) . Applying this to our patient, blockage of IL‐17A could have reduced the production of acanthosis‐inducing 1L‐22 (classic psoriasis is acanthotic), leading to a compensatory rise in the levels of IL‐17F, IL‐23 and TNF‐α, thus contributing to a new and predominantly pustular component to the disease.…”

“…A paradoxical adverse effect (PAE) is defined as an unexpected development or exacerbation of a condition during the course of a biologic therapy, when that conditions otherwise responds to that biologic. Psoriasis ( de novo , flare‐up of existing psoriasis or development of a different morphological variant of psoriasis) is the most commonly reported PAE, and has been reported after administration of infliximab and adalimumab for psoriasis, Crohn disease (CD) or rheumatoid arthritis …”

“…A few recent reports describe an exacerbation of psoriasis or development of new psoriasiform eruptions after experiencing a significant initial improvement of refractory plaque psoriasis with secukinumab . IL‐12 and IL‐23 mediate two principal pathogenetic pathways of psoriasis.…”

Paradoxical plaque psoriasis due to secukinumab treatment in an ankylosing spondylitis patient

“…1,4 There have been a few recent reports of development of paradoxical psoriasis due to SEC treatment (Table 1). 2,[5][6][7][8] In this case, the patient received two courses of SEC for AS when the papules and plaques developed on the left leg. Psoriasis is an extra-articular manifestation of AS.…”

A Case of Ixekizumab-induced Psoriasiform Eruption

“…It is known that biologics, such as tumour necrosis factor (TNF) and interleukin (IL)-12/23 (ustekinumab) blockade, can paradoxically induce psoriasiform eruptions (3)(4)(5), although the pathogenesis remains unclear (6). As for the IL-17 inhibitors, to our knowledge, there are only two reports of psoriasiform eruptions induced by secukinumab (7,8) and no reports for ixekizumab and brodalumab.…”