Acta Dermato-Venereologica Suppl 219 AbstractPsoriasis2018 | Page 41

Poster abstracts At presentation: plaque Ps on the face and scalp, nail Ps, palmo- plantar feet pustulosis (BSA–4%, PASI –2.1); both pinnas of the ears were swollen, painful and red; ear lobes were not involved. The pt suffered from conjunctivitis. The pt had asymmetrical polyarthritis, dactylitis, achillobursitis. Painful movements at cervical spine, rotation 30°-35°. ESR 54 mm/h, CRP 99 mg/l, RF negative, positive HLA B27, HLA B5 not detected. PET-CT imaging did not reveal any pathological changes besides bilateral auricular inflammation. Results: PsA diagnosis was determined according to CASPAR criteria. RP diagnosis was based on the McAdams criteria. The diagnosis is definite when no less than three out of six criteria are present: bilateral auricular chondritis, nonerosive serone- gative arthritis, nasal septum chondritis, ocular inflammation, respiratory tract chondritis, and cochlear disorder. Our pt had bilateral auricular chondritis, conjunctivitis, cochlear disorder. The diagnosis was confirmed by ear-auricles biopsy which sho- wed perichondrial inflammation and granulocyte infiltration. The therapy delivered: methotrexate s/c 10 mg pw; Solu-Medrol i/v (750 mg cumulatively); methylprednisolone per os 16 mg per day. Within days, there was normalization of temperature, e ar-auricle swelling, redness and pain had regressed; hearing was restored, conjunctivitis passed, the intensity of arthritises, dactylitis and spondylitis had decreased; the reduction in ESR, CRP was to 14 mm/h, to 7.0 mg/l accordingly. Conclusion: As is known, when a pt has PsO, he is twice as likely to develop additional autoimmune diseases. It is of great importance to properly diagnose and treat cross autoimmune di- seases. Early diagnosis (within 3 months) and adequate treatment resulted in rapidly decreased inflammatory process and in escaping nonreversible changes in cartilage tissues. P092 SPINY FOLLICULAR HYPERKERATOSIS IN A PSO­RIA­ SIS PATIENT TREATED WITH USTEKINUMAB Antoanela Carija, Adela Markota Cagalj, Neira Puizina Ivic University Hospital Centre Split Introduction: We present a psoriasis patient developing asymp- tomatic white spiny follicular hyperkeratoses (SFH) after being treated with ustekinumab for 3 months. Objectives: This type of eruption has been described under several names including spiny follicular keratoderma, hyperkeratotic spi- cules, filiform hyperkeratoses, parakeratotic horns, and follicular hyperkeratoses (1). Facial hyperkeratotic spicule eruption was re- ported in association with monoclonal gammopathy. Drug-induced filiform hyperkeratosis has been reported with cyclosporine, with BRAF inhibitors (vemurafenib), with acitretin and with vismo- degib and sorafenib. Methods: Our patient started ustekinumab treatment in June 2015. At the same time he was treated with metothrexate, folic acid, metformin and lisinopril/hydrochlorothiazide. Three months after ustekinumab introduction patient noticed growth of tiny skin projections located on the face, scalp, upper trunk and upper arms. Each spiny lesion was approximately 0.5 to 1 mm in diameter and up to 5 mm high. A biopsy of a white spiny keratotic projection sho- wed orthokeratosis, achantosis and mild spongiosis in epidermis, inflammatory infiltrate in chorium and dilatated acrotrichiums. Condition resolved in several weeks without any treatment and without ustekinumab cessation. Results: A similar condition viral-associated trichodysplasia (TS) was originally described in 1999 as a folliculocentric viral infec- tion in a patient who was receiving cyclosporine after kidney and pancreas transplantation. Trichodysplasia spinulosa associated polyomavirus (TSPyV) was identified in TS lesions and shown to be the probable cause of this disease (2). Pathogenesis both of viral-associated TS and BRAF inhibitor-induced SFH is based on the paradoxical activation of MAPK (mitogen-activated protein 39 kinase) pathway, which regulates a variety of cellular processes including cell division, differentiation and apoptosis. Conclusions: Our patient developed SFH possibly due to use of ustekinumab, IL-12 and IL-23 inhibitor. The latter has a role in differentiation process of the skin (12), suggesting that inhibition of IL-23 might explain the imperfect keratinization process observed in SFH. Considering that in our patient drug was not stopped and the condition resolved in several weeks without any treatment, possible cause could be ustekinumab-induced immunosupression and consequent viral infection. References: 1. Yanik ME, Erfan G, Albayrak H, et al. Acitretine-induced spiny follicular hyperkeratosis. Cutan Ocul Toxicol. 2016;35:165-167. 2. DeCrescenzo AJ, Philips EC, Wilkerson MG, et al. Trichodysplasia spinulosa: A rare complication of immunosuppression. JAAD Case Re- ports. 2016;2:307-309. P093 COMBINATION THERAPY OF APREMILAST AND BIOLOGICAL PRODUCT IN A PATIENT WITH PSORIASIS Koji Masuda, Fuminao Kanehisa, Norito Katoh Department of dermatology, Kyoto Prefectural University of Medicine Apremilast was approved in March 2017 in Japan for the treat- ment of psoriasis and psoriatic arthritis. Apremilast appears to have lower efficacy than biological product. However, its ease of administration as an oral agent coupled with a mild side ef- fect profile makes it an attractive option for psoriasis treatment. While monotherapy with biological products is effective for many patients with psoriasis, some patients are not satisfied by the outcome. There are few data or reports about the safety and efficacy of apremilast in combination of biological product in the treatment of psoriasis. We report a 46-year-old man with about a twenty-year history of plaque psoriasis and psoriatic arthritis who failed several therapies including topical therapy, phototherapy and etretinate. At the time of presentation, the patient was using secukinumab for 9 months, which had controlled his arthritis. However, the patient noted plaque remained mainly on his lower legs. Apremilast was added and up-titrated to 30 mg twice per day along with his secukinumab therapy. After two months of combination therapy, the patient’s disease has improved and stabilized with only a few scattered erythematous mildly scaly plaques on his lower legs. The patient denied side effects of nausea, diarrhea or headache. Laboratory- work was within normal limits. However, we also experienced two other cases who failed apre- milast add on therapy to biological product because of efficacy or side effects. So, this method may be useful for uncontrolled patient for psoriasis, more studies are needed to determine the safety and efficacy of using these drugs together. P094 PSORIASIS WORST-CASE SCENARIOS: A SERIES OF 3 CASE REPORTS Elena Popa 1 , Persa Ghitulescu 2 , Patricia Cristodor 1 , Caius So- lovan 1 Department of Dermatology and Venereology, Clinical Emergency Muni- cipal Hospital Timisoara; University of Medicine and Pharmacy “Victor Babes” Timisoara, Romania, 2 Department of Dermatology and Venereo- logy, Clinical Emergency Municipal Hospital Timisoara 1 Introduction: Psoriasis is a chronic, immune, inflammatory di- sease, that can occur at any time and it is most common in the age group 50–69. The reported prevalence of psoriasis in countries ranges between 0.09% and 11.4%, making psoriasis a serious global problem. Objectives: We present a series of 3 case reports that stand for some of the wo rst-case scenarios a Psoriasis patient could end up in. Acta Derm Venereol 2018