Successful guselkumab treatment in a psoriatic patient affected with Cornelia de Lange syndrome, and prosecution during the COVID ‐19 pandemic

Abstract

Psychomotor delay and intellectual disability are potential limitations in psoriasis management, due to low compliance, and strict dependence from caregivers intervention.We report our successful experience with a 58-year-old woman, who was genetically affected by Cornelia De Lange syndrome, which causes intellectual disability and psychomotor disorders. The patient had been already treated with topical and traditional therapies, without any clinical benefits. Eventually, she adhered to guselkumab treatment. The compliance was excellent, significant improvements were observed after only 3 months of treatment, without adverse effects. During follow-up, the COVID-19 pandemic address concern on the possible increased risk of infection due to immunosuppression. In agreement with current Italian recommendations, risk and benefits profile was discussed with the patient's legal tutor and the decision to continue the treatment was taken. Psoriasis complete clarification was maintained during the most difficult period of the Italian outbreak, allowing the patient to remain safely at home.

Histologic features of long‐lasting chilblain‐like lesions in a paediatric COVID‐19 patient

“…[1][2][3] Recently, few papers describe chilblain-like lesions (CLL) as a possible skin clue of COVID-19 among young patients and children, mostly in the absence of systemic symptoms and with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) swab negativity. [4][5][6][7][8] This observation is consistent with the atypical outbreak of CLL reported in high endemic COVID-19 Italian regions among paediatric and dermatological networks. 6 We hereby report a case of an adolescent boy with a reverse transcriptase (RT)-PCR-confirmed COVID-19 who developed long-lasting CLL.…”

“…Our case reflects the prototype reported in the literature: an adolescent in good health with occasional history of systemic symptoms preceding cutaneous lesions. [4][5][6][7][8] Interestingly, we observed in our patient long-lasting skin lesions several weeks after the first showings of the symptoms, concurrently with the positivity of the nasopharyngeal swab.…”

Cutaneous manifestations and considerations in COVID ‐19 pandemic: A systematic review

“… There were not exact data about incidence of COVID‐19 in psoriatic patients who are under treatment 47‐50,52,60,64,65,84‐87 Risk of hospitalization or death is were not higher than normal population in psoriasis patients under treatment with immunomodulators by itself, but psoriasis may be associated with comorbidities like metabolic syndrome especially in elderly people that is associated with higher mortality rate of COVID‐19 infection. Monotherapy with immunosuppressives, targeted therapies and lack of comorbidities predict the lower associated risk of COVID‐19 complications in psoriatic patients. There were not enough evidence regarding superiority of any biologic therapies for psoriasis in the SARS‐CoV‐2 outbreak. Known case of COVID‐19 or patients with confirmed risky exposures, should discontinue biologics but non‐infected non at‐risk patients could continue the treatment as previous. Preventive cessation of biologic or undertreatment of severe cases are not logical strategies, since resultant disease‐flare up and higher pro‐inflammatory state of patients (other than the significant cost, burden and impaired life quality) prone them to poorer outcomes in the case of possible infection occurrence also initiation of a biologic agent after discontinuation of another one usually accompanies by lesser response. Initiation of a biologic therapy needed to consider all circumstances and if decided to start, psoriatic patients who have other concomitant comorbidities should have more closed and frequent visits also further monitoring. There were some case reports regarding management of complicated psoriatic cases who were also affected by COVID‐19, like successful treatment with Guselkumab 86 …”

“…• There were not exact data about incidence of COVID-19 in psoriatic patients who are under treatment. [47][48][49][50]52,60,64,65,[84][85][86][87] • Risk of hospitalization or death is were not higher than normal population in psoriasis patients under treatment with immunomodulators by itself, but psoriasis may be associated with comorbidities like metabolic syndrome especially in elderly people that is associated with higher mortality rate of COVID-19 infection.…”

“…• • There were some case reports regarding management of complicated psoriatic cases who were also affected by COVID-19, like successful treatment with Guselkumab. 86…”