Emerging dermatological and systemic applications of ustekinumab: beyond its clinical use in psoriasis

I read with great interest the paper by Uhlenhake and Mehregan in a recent issue of your journal.1 The article is highly thought-provoking. Interestingly, the past few years have seen increased use of ustekinumab in clinical applications other than psoriasis. For instance, ustekinumab is effective for treatment-resistant hidradenitis suppurativa.2,3 Similarly, recalcitrant palmoplantar pustulosis responds to treatment with ustekinumab.4 When used in patients with pyoderma gangrenosum, ustekinumab attenuates the expression of interleukin-23 and results in significant resolution of lesions.5 Ustekinumab has also shown considerable promise in ameliorating the symptoms of subacute lupus erythematosus and pityriasis rubra.6,7 Further, ustekinumab is particularly effective in the treatment of nail psoriasis and erythrodermic psoriasis, both of which are relatively difficult to treat with other standard psoriasis therapies.8,9 Similarly, Alvarez et al and Sanso et al have recently reported the effectiveness of ustekinumab in the management of symptoms of Crohn’s disease.10,11 Reduction in serum C-reactive protein levels after ustekinumab therapy confirms its effectiveness in Crohn’s disease.12 Ustekinumab therapy is also promising in the management of graft-versus-host disease, especially in patients who are unresponsive to steroids.13 However, ustekinumab needs to be used carefully because its use may be associated with the development of skin malignancies, such as squamous cell carcinoma.14 Similarly, malignant melanomas may be associated with ustekinumab therapy.15 Also, neurological syndromes, such as posterior leukoencephalopathy, have been reported following administration of ustekinumab.16 Severe pustular psoriasis may result as a consequence of ustekinumab therapy in patients being treated for plaque psoriasis.17 Clearly, ustekinumab has a major role to play in the management of various systemic conditions. Hopefully, the coming few years will see increased application of ustekinumab in the management of other dermatological conditions besides psoriasis.