Ustekinumab Treatment of Erythrodermic Psoriasis Occurring after Physical Stress: A Report of Two Cases
The second case we report is a 53-year-old woman suffering from plaque-type psoriasis since adolescence, developing joint involvement since the age of 40. Various topical therapies (e.g., tar, corticosteroids, vitamin D analogues) and systemic therapies, both traditional and biological, were discontinued due to the lack of efficacy or the occurrence of adverse events (e.g., renal failure, leukopenia).\nBecause of the worsening of joint symptoms, therapy with metrotexate was reintroduced for 3 months, but ultimately suspended because of the onset of erythroderma. Treatment with intravenous methylprednisolone and ranitidine hydrochloride temporarily improved her clinical condition, but an erythrodermic relapse (PASI score: 40) was observed despite the patient undergoing treatment with small doses of oral corticosteroids (fig. ).\nTherapy with ustekinumab at the dosage of 45 mg s.c. was started as monotherapy, and after only 2 weeks (fig. ), the patient experienced an improvement of her clinical features with a visible reduction of erythema and scaling, achieving an improvement of her PASI score from baseline exceeding 75% (PASI score: 8.4). A second dose was administered 4 weeks later, and after 3 months, the patient showed a PASI score of 0 with a satisfactory control of articular symptoms, using ketoprofen as needed (fig. ). To date, the patient has been treated for 64 weeks, maintaining a PASI score of 90 with no reported side effects.