Risankizumab-Aggravated Crusted Scabies in a Patient with Down Syndrome

Abstract

Risankizumab, an interleukin (IL)-23 antagonist, is a highly effective treatment for moderate to severe psoriasis. Crusted scabies (CS) is a rare and severe form of scabies, occurring mainly in immunosuppressed patients and/or neurologically or mentally ill patients. A young girl with Down syndrome was diagnosed with a hyperkeratotic form of psoriasis. As treatment with topical dermocorticosteroids, UVB-phototherapy and acitretin for 6 weeks did not improve the lesions, two injections of risankizumab were administered. Following these injections, the lesions became rapidly even more severely crusted, and new lesions appeared on the extremities and the face of the patient. There was histological evidence of a high charge of scabies, leading to a diagnosis of CS. The patient was hospitalized and successfully treated by local permethrine and systemic ivermectine. This case suggests that even though anti-IL23 antagonists display an excellent overall safety profile, a particular caution for infections should still be respected in patients with underlying risk factors.

Norwegian Scabies in an Atopic Patient Under Dupilumab Treatment

“…Dupilumab blocks the activity of interleukin 4 (IL-4) and IL-13, 2 key cytokines of the helper T cell 2 immune response that are essential in fighting parasites 1 . Although no data on a possible increase of Norwegian scabies with dupilumab therapy have been reported up to date, cases have been published in the context of other biological therapies that inhibit important cytokines of the helper T cell 2 route (anti–IL-23, anti–tumor necrosis factor) 2–5 …”

“…1 Although no data on a possible increase of Norwegian scabies with dupilumab therapy have been reported up to date, cases have been published in the context of other biological therapies that inhibit important cytokines of the helper T cell 2 route (anti-IL-23, anti-tumor necrosis factor). [2][3][4][5] PEARL Norwegian scabies should be considered in any outbreak of new-onset pruritic dermatitis in dupilumab-treated patients.…”

“…In contrast, no cases after ipilimumab (anti-cytotoxic T-lymphocyte antigen 4) were retrieved. 2 According to Terrier et al, 2 nivolumab only induced isolated morphea plaques, whereas pembrolizumab mainly induced generalized lesions. Interestingly, most cases correlated with cancer remission or stable disease despite anti-PD-1 discontinuation, although the scarcity of casuistry and follow-up data preclude a statement about prognosis.…”

Common Dermatologic Disorders in Down Syndrome: Systematic Review

“…There was 1 observational study of a scabies outbreak among persons with mental disability, which reported an index case of a 16-year-old patient with DS [79]. There were also 7 case reports of scabies (Multimedia Appendix 6) [15,16,[80][81][82][83][84], where 4 of the cases reported an initial misdiagnosis of scabies, and the patients were instead treated ineffectively for presumed onychomycosis, psoriasis, eczema, tinea corporis, and psoriasiform dermatitis [16,[80][81][82]84]. There were also 4 case reports of leishmaniasis (Multimedia Appendix 7) [74,[85][86][87] and 1 case report of actinomycetoma [88].…”

Dermatologic conditions in Down syndrome

“…28,63 Also, several informative case reports describing crusted scabies initially misdiagnosed as psoriasis and inappropriately treated with immunosuppression are found. [64][65][66][67] Crusted scabies may be more common in DS given underlying immunodeficiency and immune dysregulation; it is well documented that immunocompromised patients are at increased risk of developing crusted scabies. Given this knowledge, crusted scabies should be on the differential diagnosis when a patient with DS presents with generalized erythrodermic dermatitis, keratoderma, or onychodystrophy.…”