Morphea in a patient undergoing treatment with ustekinumab

Plaque psoriasis and morphea in a patient on ustekinumab: A case report

“…This upregulation in profibrotic cytokines leads to the production and deposition of collagen while also inhibiting the degradation of the extracellular matrix. 6 In addition, the T-helper 2 (Th2) pathway involved in humoral immunity is also implicated in morphea development. 7 Psoriasis, a chronic immunologically mediated inflammatory condition, develops in response to self-antigens which may be triggered by a combination of immune defects and genetic, hormonal, and environmental factors.…”

“…The Th17 pathway and cytokines IL-17, IL-21, and IL-23 are believed to significantly impact the pathogenesis of inflammatory autoimmune conditions. 6,13 Both the Th2 and Th1 pathways implicated in the pathogenesis of morphea and psoriasis, respectively, interact with the Th17 pathway; thus, it is postulated that dysregulation of this pathway may lead to the coexistence of these conditions in the same patient. 6,7,[14][15][16] Ustekinumab is a monoclonal antibody used to treat moderate-to-severe psoriasis that blocks both IL-12 and IL-23 through their shared p40 protein subunit, which leads to the suppression of the Th1 and Th17 pathways.…”

The emergence of morphea in a patient undergoing ustekinumab therapy given for psoriasis

“…Upregulation of TGF-beta causes production and deposition of collagen and inhibition of extracellular matrix degradation. 3,4 Psoriasis is a complex disease, which has both autoinflammatory and autoimmune components. The balance between the autoinflammatory and autoimmune processes is significant in shaping its clinical presentation.…”

“…It is argued that dysregulation of Th17 pathway, which is responsible for regulation of both Th1 and Th2 immune response, could be accused of the coexistence of morphea and psoriasis in the same patient. 4,7,8 Steuer et al observed that morphea lesions improved following cessation of UST. 4 Therefore, it is thought that UST may trigger Th2-mediated diseases like morphea via supressing Th1 responses and causing enhanced Th2 cell responses relatively.…”

“…4,7,8 Steuer et al observed that morphea lesions improved following cessation of UST. 4 Therefore, it is thought that UST may trigger Th2-mediated diseases like morphea via supressing Th1 responses and causing enhanced Th2 cell responses relatively. 4,7 Although UST is generally thought to be a safe drug, it is also important for dermatologists to be aware that UST therapy given for psoriasis may be related with the onset of morphea.…”