Ciclosporin

Abstract

Lack of efficacy : case report A 41-year-old man exhibited lack of efficacy following treatment with ciclosporin for erythroderma. The man presented in the emergency department with a 8-weeks history of disseminated and itchy plaques. Physical examination and laboratory findings were consistent with the pityriasis rubra pilaris (PRP). He initially treated with prednisolone, mometasone and urea-containing externals. He also received light therapy which was ineffective and was terminated prematurely. Thereafter, acitretin therapy was initiated which showed a progressive increase in findings. Hence, the dose of acitretin was increased. After 3 months of retinoid therapy, he presented with erythroderma. Thereafter, he switched to ciclosporin [cyclosporine A] 300 mg/d (3.5 mg/kg) [route not stated] for three months. However, ciclosporin treatment remained unsuccessful. During ciclosporin therapy, he had a marked increase in orange hyperkeratosis palmoplantar. Therefore, he received SC adalimumab monotherapy for 14 days, which led to complete healing of PRP lesions and erythroderma.