Treatment of paradoxical eczematous eruption in psoriasis treated with secukinumab: A case report

Abstract

Rationale: Eczematous eruption is an increasingly recognized form of drug-related eruption, typically reported in association with interleukin 17 (IL-17)A inhibitors. However, severe paradoxical eczematous eruption due to IL-17A inhibitors has been rarely reported. Herein, we reported a case of a man with severe psoriasis with erythematous scaly plaques on the scalp, trunk, and arms and legs after the administration of secukinumab was initiated. Patient concerns: We reported a case of a 20-year-old man with severe psoriasis with erythematous scaly plaques on the scalp, trunk, and arms and legs after the administration of secukinumab was initiated. A skin biopsy was performed. It revealed spongiotic dermatitis consistent with eczematous reaction. Direct and indirect immunofluorescence assays were negative. Diagnoses: He was diagnosed with eczematous eruption. Interventions: Discontinuation of secukinumab and administration of cyclosporine and prednisone were considered. Outcomes: Significant improvement was observed, with no adverse events. Conclusion: Our case shows that eczematous eruption can paradoxically occur in patients on IL-17A inhibitors and this report is expected to increase awareness of the rising number of cutaneous eruptions related to biological agents.

Paradoxical Eczematous Reaction in a Patient With IL-17 Inhibitor-Treated Psoriasis Vulgaris

“…T helper 1 (Th1), Th17, and IL-17 are cytokines that have been identified as largely contributing to psoriasis, whereas Th2, IL-4, and IL-13 overproduction have been known to cause atopic dermatitis [ 7 ]. Researchers have suggested that when administering an IL-17 inhibitor, the Th1 and Th17 cytokines are diminished, which results in an imbalance in the Th2 immune response, causing a paradoxical eczematous reaction [ 5 ]. Due to dampening the cytokines that trigger psoriasis, there is a shift to cytokines favoring the opposing cutaneous condition of atopic dermatitis.…”

“…Eczema was a rare adverse event that affected 67 out of 1,230 patients [ 4 ]. One such reaction, the paradoxical eczematous response triggered by IL-17 inhibitor biologics, has been well documented with various cases published [ 3 , 5 , 6 ]. We present a case of a 14-year-old male with recalcitrant psoriasis vulgaris who developed a paradoxical eczematous reaction while undergoing treatment with secukinumab.…”

Secukinumab-Induced Bullous Pemphigoid in a Patient With Psoriatic Arthritis

“…However, there have also been reports of rare manifestation of eczematous dermatitis, IgA vasculitis, and lymphocytic colitis after its use. [3][4][5] Bullous pemphigoid is an autoimmune blistering disease that classically presents as tense, fluid-filled bullae on skin. The pathogenesis of bullous pemphigoid is very broad and can include factors such as central neurological disorders, old age, infections, and medications.…”

“…1 Continuous intravenous infusion of sedative agents is a common practice in ICUs, with propofol being the most frequently sedative-hypnotic agent. 2,3 Although its onset is rapid, propofol has considerable disadvantages, such as hypertriglyceridemia, pain on injection, risk of infection, and propofol infusion syndrome. 3,4 Scientists are making a constant effort to…”

“…However, there have also been reports of rare manifestation of eczematous dermatitis, IgA vasculitis, and lymphocytic colitis after its use. 3–5…”