Erythrodermic psoriasis in a dialyzed patient successfully treated with Secukinumab

Erythrodermic psoriasis is a severe, life‐threatening condition with additional complications, when occurring in hemodialyzed patients, as the majority of treatments are contraindicated. A 44‐years‐old man, of Philippine origins, with a 15‐years‐history of psoriasis treated with cyclosporine developed progressive hypertension and renal insufficiency. Despite drug dismission, renal function worsen to end‐stage, and hemodialysis was necessary three times a week. Phototherapy was not able to control the skin condition, progressing to erythroderma, and after nephrology consultation, the patient consent to the off‐label secukinumab treatment, at the standard regimen (300 mg subcutaneously once weekly at weeks 0‐4 followed by 300 mg every 4 weeks). Seven days after the first injection, a rapid improvement was noted, with the psoriasis area severity index (PASI) score passing from 31.5 to 17.6. At the 52‐week‐follow‐up visit, the patient was completely clarified, without any side effects. The case supports secukinumab effectiveness and safety in difficult patients, including erythrodermic psoriasis with end‐stage renal failure, as drug plasma levels seem not to be affected by hemodialysis. Results are rapidly achieved, and long term maintained, with the additional advantage of a very comfortable monthly administration.