Erytrhodermic psoriasis (EP) is a rare subset of psoriasis that is considered a dermatologic emergency. Due to its limited clinical evidence, pathogenesis is largely unknown and its treatment represents a challenge. Conventional therapies such as methotrexate, cyclosporine, and acitretin are still considered first-line of treatment but it is necessary to study the efficacy and safety of biologics, including antitumor necrosis factor (TNF), anti-interleukin (IL)-23, and anti-IL17 agents to define new guidelines of treatment. Here, we report two cases of patients with EP treated with ixekizumab.

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pro-inflammatory protein kinases and chemokines. 3 Paradoxical psoriasis is reported in relation to biologics, included brodalumab. 4,5 Many conditions must be considered when selecting the best treatment for psoriasis. iTNF-induced psoriasis should now be added to that list. 6,7 In the literature there are not other reports on the use of brodalumab in paradoxical psoriasis. In our case report, brodalumab proved to be effective and well-tolerated for the treatment of paradoxical reaction induced by iTNF with rapid action and no adverse effects in the short follow-up. Further studies are needed to identify new recommended strategies to better manage these patients.