Acta Dermato-Venereologica 99-4CompleteContent | Page 21

SHORT COMMUNICATION
A Case of Ixekizumab-induced Psoriasiform Eruption
Tomohiro OIWA, Mafumi FUJITA, Sawako TAKASE, Youichi NISHIMURA, Miyuki OTA, Kayo OKADA and Takao TACHIBANA
Department of Dermatology, Osaka Red Cross Hospital, 5-30 Fudegasaki-cho, Tennoji-ku, Osaka 543-8555, Japan. E-mail: tomoski@kuhp.
kyoto-u.ac.jp
Accepted Feb 5, 2019; E-published Feb 6, 2019
Psoriasis is a common chronic inflammatory skin disease.
The current understanding of the immunopathogenesis
and inflammatory cytokine pathways enables us to deve-
lop and introduce biological therapies for the treatment
of moderate to severe psoriasis (1). Anti-IL-17 (anti-
interleukin-17) inhibitors, such as ixekinumab (anti-IL-
17A antibody), secukinumab (anti-IL-17A antibody) and
brodalumab (anti-IL-17 receptor A (IL-17RA) antibody)
exert excellent therapeutic effects on psoriasis. Since
IL-17 is an important cytokine for preventing fungal
infections, adverse skin reactions such as cutaneous can-
didiasis are occasionally experienced during the admi-
nistration of IL-17 inhibitors (2), however little is known
about other adverse skin reactions of these inhibitors.
It is known that biologics, such as tumour necrosis
factor (TNF) and interleukin (IL)-12/23 (ustekinumab)
blockade, can paradoxically induce psoriasiform erup-
tions (3–5), although the pathogenesis remains unclear
(6). As for the IL-17 inhibitors, to our knowledge, there
are only two reports of psoriasiform eruptions induced
by secukinumab (7, 8) and no reports for ixekizumab
and brodalumab.
Here, we report the first case of psoriasiform eruptions
induced by ixekizumab.
446
CASE REPORT
A 76-year-old man (162 cm, 56 kg) was diagnosed with psoria-
sis vulgaris over 20 years ago. He had been treated with topical
therapies (calcipotriol/betamethasone, clobetasol propionate, and
other topical corticosteroids) and narrowband UVB (ultraviolet B)
phototherapy; however, the psoriatic lesions were persistent on the
elbows, dorsum of the hands, knees and lower limbs.
He was treated with ixekizumab (80 mg/2 weeks/body), and
by 4 weeks of treatment, the psoriatic lesions disappeared, except
on the knees. The fifth dose of ixekizumab was administered 8
weeks after the initiation of treatment, when mild scaly erythema
developed on the lower limbs, which was not observed before.
Fungal infection was negative in the lesions. Three days later, both
erythema and oedema were observed on most of the body including
the palms and soles (Fig. 1a), and the body temperature was up
to 38.0°C. Because the skin lesions progressed to erythroderma
accompanied by thick scales, the sixth dose of ixekizumab was
not administered and clobetasol ointment was started. Skin biopsy
from the scaly erythema on his left thigh, presented pathological
findings compatible with psoriasis (Fig. 2).
Three weeks after the last administration of ixekizumab, the
scaly erythema and oedema improved, however, psoriatic lesions
were still persistent, especially on palms, soles, and lower limbs.
We therefore started oral cyclosporine (150 mg/day) treatment.
One week later, these skin lesions gradually improved, and we
continued the administration of cyclosporine as the patient refused
further biological treatments. Twelve weeks after the last admi-
nistration of ixekizumab, the skin lesions were mostly resolved.
Fig. 1. Clinical findings.
(a) After the fifth dose of
ixekizumab, both erythema
and oedema were observed
on most of the body,
including the palms and
soles. (b) Twelve weeks after
the last administration of
ixekizumab, the skin lesions
were mostly resolved.
However, the skin lesions
on the knees remained.
Minimal scary erythema
was observed on the knees.
doi: 10.2340/00015555-3138
Acta Derm Venereol 2019; 99: 446–447
This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta
Journal Compilation © 2019 Acta Dermato-Venereologica.