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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.