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Advances in dermatology and venereology Acta Dermato-Venereologica
Eyelid Dermatitis as a Side Effect of Interleukin-17A Inhibitors in Psoriasis
Yuichi TERAKI , Aya TAKAHASHI , Yumiko INOUE and Saori TAKAMURA Department of Dermatology , Saitama Medical Center , Saitama Medical University , 1981 Kamoda , Kawagoe , Saitama 350-8550 , Japan . E-mail : teraki @ saitama-med . ac . jp Accepted Dec 20 , 2017 ; Epub ahead of print Dec 20 , 2017
The interleukin ( IL ) -17A inhibitors , secukinumab and ixekizumab , are successfully used for the treatment of psoriasis and psoriatic arthritis ( 1 – 3 ). Both secukinumab and ixekizumab have favorable safety profiles , although various adverse events have been reported in patients treated with IL-17A inhibitors ( 4 – 6 ). Common adverse events after using IL-17A inhibitors include nasopharyngitis , headache , upper respiratory infection , pruritus , and injection site reactions . Mucocutaneous candidiasis and neutropenia are more common in patients treated with IL-17A inhibitors than in those treated with tumor necrosis factor-α and IL-12 / 23 inhibitors . However , little is known about eyelid dermatitis following therapy with IL-17 inhibitors ( 4 – 6 ). Here , we report 3 cases of eyelid dermatitis following therapy with IL-17A inhibitors for patients with psoriasis .
CASE REPORTS
Case 1 . A 33-year-old woman was referred to our dermatology clinic with a psoriatic arthritis . The patient had a 20-year history of plaque psoriasis on the scalp and extremities and developed arthralgia on the right ring finger and right 4 th toe 2 months earlier . The psoriasis area and severity index ( PASI ) was 3.0 and disease activity score 28-C-reactive protein value was 3.2 . The patient had been treated with 300 mg secukinumab at weeks 0 , 1 , 2 , 3 , and 4 , followed by 300 mg every 4 weeks . Treatment with secukinumab resulted in rapid remission of both psoriatic lesions and arthritis . The patient developed eyelid dermatitis 3 months after the initiation of secukinumab therapy . The patient did not use any eye drops and eyelid cosmetics . A physical examination revealed erythematous lesions with flaking scales on the eyelid margins and scaling on the eyelashes ( Fig . 1a ). Neither itching nor conjunctivitis was observed . Potassium hydroxide examination of the scales did not reveal any fungal elements . Treatment with topical corticosteroids did not improve eyelid lesions . Finally , the eyelid dermatitis resolved after discontinuation of secukinumab .
Case 2 . A 52-year-old man was referred to our dermatology clinic with a 15-year history of plaque psoriasis . A physical examination revealed psoriatic plaques on the trunk and extremities , with a PASI of 16.4 . The patient had been treated with 300 mg secukinumab at weeks 0 , 1 , 2 , 3 , and 4 , followed by 300 mg every 4 weeks . Treatment with secukinumab completely cured the psoriatic lesions within 3 months . At that time , the patient involved
Fig . 1 . Clinical features . a ) Case 1 . Erythematous lesions with flaking scales on the eyelid margins and scaling on the eyelashes , which developed 3 months after the initiation of secukinumab for treating psoriatic arthritis . b ) Case 2 . Erythematous lesions with scaling and mild lichenification on the eyelids , which developed 4 months after the initiation of secukinumab for treating plaque psoriasis . c ) Case 3 . Scaly erythematous lesions with slight lichenification on the eyelids , which developed 4 months after the initiation of ixekizumab for treating pustular psoriasis .
mild oral candidiasis , which was promptly improved by treatment with oral itraconazole . He developed eyelid dermatitis 4 months after the initiation of secukinumab therapy . An examination revealed erythematous lesions with scaling and mild lichenification on the eyelids ( Fig . 1b ). The patient had little itching . No relapse of psoriasis was found on the skin . Treatment with topical corticosteroids improved eyelid lesions ; therefore , secukinumab therapy was continued .
Case 3 . An 89-year-old man was referred to our dermatology clinic with a 2-year history of psoriasis involving the trunk , extremities , and scalp . A physical examination doi : 10.2340 / 00015555-2871 Acta Derm Venereol 2018 ; 98 : 456 – 457
This is an open access article under the CC BY-NC license . www . medicaljournals . se / acta Journal Compilation © 2018 Acta Dermato-Venereologica .