Pyoderma gangrenosum induced by secukinumab—A late paradoxical drug reaction

Pyoderma gangrenosum induced by secukinumab in a patient with psoriasis successfully treated with ustekinumab

“… 1 However, inhibition of IL-17A may also paradoxically increase IL-23 production, triggering the development of pyoderma gangrenosum as observed in our patient and 2 similar cases reported in Japan and Germany. 6 , 7 All cases were found in patients with psoriasis, suggesting a possible association between pyoderma gangrenosum and IL-17A inhibition in this patient population. Our patient's pyoderma gangrenosum lesions improved significantly after she received ustekinumab, further demonstrating that paradoxical IL-23 upregulation may be driving the development of pyoderma gangrenosum in patients treated with IL-17A–targeting biologics.…”

Pyoderma gangrenosum treated with secukinumab: A case report

“…Interestingly, there are several recent anecdotal reports of pyoderma gangrenosum being paradoxically induced by IL-17 inhibitors. 11 – 13 Different theories have been proposed to explain these paradoxical reactions to biologic agents, including an imbalance in cytokine production, unopposed production of interferon alpha (IFN-α), and a shift towards a Th1 cytokine profile. 14 , 15 While the IFN-α pathway has been identified as an alternative pathway in paradoxical psoriasis reactions caused by biologic therapy, 16 the pathogenesis of IL-17 inhibitor-induced pyoderma gangrenosum is largely unknown and there are likely multiple inflammatory pathways of disease induction.…”

Onset of Pyoderma Gangrenosum in Patients on Biologic Therapies: A Systematic Review

“…Anti-CD20 (n = 41) [9][10][11][12][13][14][15] TNF-α Inhibitor (n = 12) [16][17][18][19][20][21][22][23][24][25][26][27] IL-17A Inhibitor (n = 3) [28][29][30] CTLA-4 Antibody (n = 1) 31 Biologic name (n) Rituximab ( 41) Infliximab ( 5) Adalimumab ( 4) Certolizumab ( 1) Etanercept ( 1)…”