Paradoxical Psoriasis Induced by Ustekinumab: A Comprehensive Review and Case Report
Abstract
1. Introduction
2. Case Report
3. Literature Review
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Author and Year [Reference] | Patient ID | Age | Sex | Previous Psoriasis History | Ustekinumab Treatment Duration | Dose of UST | How Long after UST Did Lesions Appear | Type of Paradoxical Psoriasis | Location of Paradoxical Psoriasis | Severity (PASI Score) | How Was Paradoxical Psoriasis Flare Controlled | Comorbidities | Therapy Prior to UST | Time to Resolution | Management Strategy (Discontinuation, Switching to Other Agent, Etc.) |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Our case | 1 | 39 | Female | Three years (from 2020 to 2023) | Three years | Psoriasiform (biopsy-proven) | Hands, elbows, and scalp | Topical steroids | Crohn’s Disease (CD) | Infliximab, adalimumab | Continued UST with topical treatment | ||||
Barahimi et al., 2021 [18] | 2 | 51 | Male | No history of psoriasis | Three years | 90 mg | Three flares separated lasting several weeks; one flare per year | Subcorneal pustular dermatosis | Hands, body, face, extremities, and scalp | 10–15 (moderate) | Topical corticosteroids; second flare managed with discontinuation | Crohn’s disease and enteropathic arthritis | Adalimumab, infliximab, and methotrexate | Three weeks | Discontinuation of UST during flares and restarting therapy once flares resolved |
Benzaquen et al., 2018 [19] | 3 | 58 | Female | No history of psoriasis | Three weeks | 390 mg | Three weeks | Paradoxical Palmoplantar Pustular Psoriasis | Right hand palm | 0–5 (mild) | Discontinuation, golimumab | Asthma, corticosteroid-induced osteoporosis, arthritis, Crohn’s disease, spondyloarthropathy | Systemic corticosteroids, mesalazine, azathioprine, adalimumab, and infliximab | 15 days | Discontinuation of UST, switched to golimumab |
Suh et al., 2018 [20] | 4 | 30 | Male | 6-year history of psoriasis | Two weeks | 45 mg | One week after the first injection | Possibly pustular psoriasis, but not definitively diagnosed | Trunk, lower extremities, scalp, palms, and soles | Not available | Discontinuation, oral cyclosporin and a topical agent | Not available | Previously treated with infliximab phototherapy, acitretin, and cyclosporine. | One week | Discontinuation of UST and initiation of treatment with oral cyclosporin and a topical agent |
Darwin et al., 2018 [21] | 5 | 56 | Female | Palmoplantar psoriasis | 15 months | 90 mg monthly | 15 months | Inverse psoriasis | Inter-gluteal cleft and genital area | 0–5 (mild) | Tacrolimus cream daily and pulsed clobetasol cream as necessary on weekends | Crohn’s disease, rheumatoid arthritis | Infliximab, adalimumab, thalidomide, and hydroxychloroquine | Not provided | Medications were not halted as her Crohn’s disease was well controlled under the current medication regimen |
Lee et al., 2017 [22] | 6 | 24 | Male | 7-year history of psoriasis vulgaris | 12 weeks | 45 mg | After the third injection | Plaque psoriasis | Face, trunk, and extremities | 10–15 (moderate) | Systemic steroid and NBUVB phototherapy | None | NBUVB phototherapy, acitretin, methotrexate, and cyclosporine | Two weeks | Addition of systemic steroid and NBUVB phototherapy, but patient discontinued treatments after 2 weeks and was lost to follow-up |
Hay et al., 2014 [23] | 7 | 47 | Male | 15-year history of plaque psoriasis | One month | 45 mg | Before the second dose, one month later | Pustular psoriasis | 60% of body surface area | >15 (severe) | Discontinuation and adalimumab | Psoriatic arthropathy | Methoxetrate, acitretin, ciclosporin, and narrowband ultraviolet B phototherapy | Two weeks | Discontinuation of UST, switching to adalimumab |
Caca-Biljanovska et al., 2013 [24] | 8 | 34 | Female | Severe plaque psoriasis since the age of 10 | >18 months | 45 mg | Week 10, after two injections | Pustular psoriasis | Trunk and limbs | >15 (severe) | Topical corticosteroids and intensification of UST | NA | Topical corticosteroids, psoralen plus ultraviolet A irradiation (PUVA), and acitretin | Four weeks | Continued UST therapy |
Wenk et al., 2012 [25] | 9 | 37 | Female | 10-year history of plaque psoriasis | 12 weeks, injection at day 0, week 4, and week 12 | 45-mg | Four days after first injection and subsequently after second and third injection | Pustular psoriasis | Trunk and limbs | >15 (severe) | Discontinuation and systemic and topical steroids | Psoriatic arthritis | Infliximab, adalimumab, cyclosporine, acitretin, narrow band ultraviolet B irradiation, etanercept, methotrexate, systemic steroid treatment, topical steroids, and acitretin | Not specified | Discontinuation of UST and switch to acitretin |
Gregoriou et al., 2011 [26] | 10 | 54 | Female | 5-year history of plaque psoriasis | NA | 45 mg | Two days after first injection | Pustular psoriasis | Trunk and both upper and lower extremities | >15 (severe) | Discontinuation of UST and replacement with methotrexate 25 mg per week with folic acid supplementation | Diabetes type II, hypertension, and hypercholesterolemia | Metformin 500 mg BID for diabetes type II, ramipril 2.5 mg QD for hypertension, and simvastatin 20 mg QD for hypercholesterolemia, topical corticosteroids, calcipotriol, and a calcipotriol-betamethasone dipropionate two compound formulation for 3 years | Two months | Discontinuation of UST and replacement with methotrexate 25 mg per week with folic acid supplementation |
Safa et al., 2011 [27] | 11 | 35 | Female | No personal history but had a family history | Started at weeks 0 and 4 | 45 mg | After six weeks and two injections | Exacerbation of Infliximab-induced palmoplantar psoriasis | Palms and soles | Not specified | Improved with oral methotrexate after discontinuation of ustekinumab | Ankylosing spondylitis | Nonsteroidal anti-inflammatory drugs, adalimumab, etanercept, and infliximab | Two months | Discontinuation of ustekinumab |
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Olteanu, A.O.; Klimko, A.; Tieranu, I.; Orzan, O.A.; Toma, C.V.; Ionescu, E.M.; Preda, C.M.; Tieranu, C.G. Paradoxical Psoriasis Induced by Ustekinumab: A Comprehensive Review and Case Report. Medicina 2024, 60, 106. https://doi.org/10.3390/medicina60010106
Olteanu AO, Klimko A, Tieranu I, Orzan OA, Toma CV, Ionescu EM, Preda CM, Tieranu CG. Paradoxical Psoriasis Induced by Ustekinumab: A Comprehensive Review and Case Report. Medicina. 2024; 60(1):106. https://doi.org/10.3390/medicina60010106
Chicago/Turabian StyleOlteanu, Andrei Ovidiu, Artsiom Klimko, Ioana Tieranu, Olguta Anca Orzan, Cristian Valentin Toma, Elena Mirela Ionescu, Carmen Monica Preda, and Cristian George Tieranu. 2024. "Paradoxical Psoriasis Induced by Ustekinumab: A Comprehensive Review and Case Report" Medicina 60, no. 1: 106. https://doi.org/10.3390/medicina60010106
APA StyleOlteanu, A. O., Klimko, A., Tieranu, I., Orzan, O. A., Toma, C. V., Ionescu, E. M., Preda, C. M., & Tieranu, C. G. (2024). Paradoxical Psoriasis Induced by Ustekinumab: A Comprehensive Review and Case Report. Medicina, 60(1), 106. https://doi.org/10.3390/medicina60010106