Erythrodermic Psoriasis Treatment with Ustekinumab

• Erythrodermic psoriasis (EP) is a generalized, inflammatory erythematous dermatosis, with or without exfoliation lasting for at least 3 months involving 75% or more of the body surface

Methods:

• In this retrospective study PASI evaluation was done at 4, 16 and 28 weeks of treatment
• 22 patients
• dosage of 45mg in 16 patients
• dosage of 90mg in 6 patients
• reasons for discontinuation
  • failure of PASI 50 at week 28: 2 patients
  • severe adverse events; 1 patients who had tuberculosis reactivation
  • clinical remission:  4 patients

Results:

• PASI 50 in more than 80% of patients at week 16 (regardless of the dosage)
• PASI 75 in 75% of cases at week 16 (at 45mg). Interestingly only 50% achieved PASI 75 at a dosage of 90mg (since the study was retrospective the dosage may have been increased because of ineffective response at 45mg). PASI 75 was reached in more than 80% of patients at week 28 regardless of the dosage.
• PASI 90 was reached at week 28 in 75% of patients at week 28 (45mg)

No guidelines exist for the management of erythrodermic psoriasis (because of the low prevalence of the condition) and this study shows that  ustekinumab is an effective treatment treatment for EP, providing rapid and significant clinical response associated with a good safety profile

Contributors

Dr Christophe Hsu – dermatologist. Geneva, Switzerland

Source of information: p333 ustekinumab and erythrodermic psoriasis; the Italian Experience. PesciPhoneli L. et al. EADV Annual Meeting (2014), Amsterdam The Netherlands