Atopic‐like dermatitis after secukinumab injection: A case report

Abstract

Dear Editor Psoriasis is a chronic, immune-mediated inflammatory skin disease which is associated with a substantial detriment to physical and psychological quality of life (Cozzani et al., 2010). For this reason, it is imperative to find an effective and safe therapy. A new class of biologic therapy that targets IL-17A has been discovered. One of these agents, secukinumab (Novartis Pharmaceuticals), is an injectable, fully human monoclonal antibody and was recently approved by the US Food and Drug Administration for treatment of moderate to severe plaque psoriasis (Langley et al., 2014). Secukinumab is safe and effective as showed in several clinical trials. The most common adverse effects reported were infection, nasopharyngitis, headaches, pruritus, hypertension, and back pain (Blauvelt et al., 2015; Paul et al., 2015). We report secukinumab-induced recurrent blepharitis, cheilitis, and nose dermatitis, occurred at the same patient while was on therapy. A 70-year-old woman with intractable psoriasis vulgaris was treated with 300 mg of secukinumab. Before starting the biologic therapy, her psoriasis area and severity index (PASI) was 15 and cyclosporine as well as methotrexate were given with no success. After 6 months the first dose of secukinumab was administered, she reached PASI 100. However she noticed recurrent blepharitis, cheilitis, and nose-dermatitis, 4 days after every secukinumab injection. She was referred to our department for an evaluation of her skin eruption. She had no personal or family history of atopic dermatitis. On examination, erythematous papules, excoriation, and serous exudation were present at both lids, nostrils ad at the corners of her mouth (Figure 1). There were no blisters and the diagnosis of a possible herpes discarded. A culture taken from all the three sites, ruled out a diagnosis of superficial dermatophytosis and candidiasis as well as bacterial infection. A blood test showed eosinophilia. An atopic dermatitis eczema-like was diagnosed and secukinumab stopped, consequently her skin eruption remarkably improved. Regrettably, after 9 months of complete clinical remission, psoriasis reoccurred, fortunately, it was not severe and therefore treatable with just topicals and phototherapy. Secukinumab is a fully human anti-interleukin-17A monoclonal antibody. It has proven to be efficient and safe in moderate-to-severe plaque psoriasis, as showed in several clinical trials. In the study FEATURE, only oral and vulvovaginal candidiasis and injection site reactions were reported with regards to cutaneous adverse reactions. All side effects were mild and did not lead to the study treatment discontinuation. Searching through MEDLINE with regards to real life, only a few cases of secukinumab cutaneous adverse events are reported. A drug eruption and a perianal dermatophytosis were reported during secukinumab therapy (Quach & Hsu, 2016; Shibata et al., 2017), but no cases of eczema. However, it is a different matter with regards to anti-TFNa research. Nakamura et al. reviewed the literature and selected 15 pieces which relate to eczema while on antiTNFa therapy. (Nakamura et al., 2017). In these 15 cases, the eczema diagnosis was mainly clinical, just like in our case, and a biopsy was done only when the diagnosis was uncertain. Furthermore, Esmailzadeh noticed how a personal history of atopy was a risk factor of developing an eczema during anti-TNFa therapy, although not a prerequisite condition, like in our patient s case. (Esmailzadeh et al., 2009). The reason why an eczema developed during the anti-TNF therapy can be attributed to the fact psoriasis and eczema are thought