Psoriasis with facial skin lesions that arose against background of withdrawal of ixekizumab (clinical case)

Abstract

Facial skin lesions in psoriasis, one of the most common dermatoses, are traditionally considered a relatively rare manifestation of the disease, especially in adult patients, but according to modern data, it is observed in at least 40 % of patients. It is believed that facial skin lesions are more typical for young patients with severe widespread skin lesions, involvement of the nail plates and a protracted course. Localization of rashes on the skin of the face – in a cosmetically and socially significant area – is accompanied by significant impairments in the quality of life of patients. The treatment of facial psoriasis is difficult, and few algorithms have been developed for the management of patients with facial psoriatic lesions. We present a patient with psoriasis involving facial skin that first developed after discontinuation of systemic therapy with an IL-17A inhibitor (ixekizumab). During the follow-up of the patient, it became necessary to re-administer systemic biological therapy with the potential risk of an escape effect. In the article, we discuss the clinical manifestations of facial psoriasis and the impact on the quality of life of patients. A description of the observation of a patient with lesions of the facial skin in severe plaque psoriasis and the role of biological therapy in this direction is presented.