Open AccessConcurrent Atopic Dermatitis and Psoriasis Vulgaris: Implications for Targeted Biologic Therapy
Author(s) -
; Johnson
Publication year - 2022
Publication title -
cutis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.289
H-Index - 53
eISSN - 2326-6929
pISSN - 0011-4162
DOI - 10.12788/cutis.0453
Subject(s) - secukinumab , dupilumab , medicine , atopic dermatitis , psoriasis , interleukin 23 , dermatology , immunology , interleukin 17 , inflammation , psoriatic arthritis
Psoriasis vulgaris, a helper T cell T H 1/T H 17-mediated inflammatory dermatosis, may be effectively treated with biologic medications such as secukinumab, an IL-17A inhibitor. However, suppression of the T H 1-mediated axis may result in the paradoxical appearance of T H 2-mediated inflammatory skin conditions, such as atopic dermatitis (AD). Dupilumab, a biologic medication that inhibits IL-4/IL-13-cytokines involved in T H 2-mediated inflammation-has demonstrated efficacy in treating AD but may result in phenotypic switching to psoriasis. We describe a patient with psoriasis that was well controlled on secukinumab who developed severe AD that improved with dupilumab. After several months of effective treatment with dupilumab, he subsequently developed re-emergence of psoriatic lesions. This case highlights how pharmacologic interventions targeted at specific immunologic pathways, such as the T H 1/T H 2 axis, may have unintended consequences.