Vaccine‐induced erythrodermic psoriasis in a child successfully treated with secukinumab: A case report and brief literature review

Abstract

We report a case of a 7-year-old male patient with vaccine-induced erythrodermic psoriasis (EP) complicated by pulmonary infection, hypoproteinemia, and liver dysfunction successfully treated with secukinumab in combination with symptomatic and supportive therapy. The patient presented with diffuse flushing on the head, face, trunk, and limbs, which were covered with chaff-like white scales in the rashaffected area, with no blisters, pustules, and no apparent abnormalities in the palms, soles, nails, and joints. Histopathology analysis revealed hyperkeratosis, focal parakeratosis, thinning or effacement of the granular layer, psoriasiform hyperplasia of the epidermis, neutrophilic microabscess formation in the upper part of the epidermis, edema of the dermal papilla, dilation of blood vessels, and lymphocyte infiltration. The patient was eventually diagnosed with EP. At weeks 0, 1, and 2, the patient received a subcutaneous injection of 150 mg secukinumab (three injections). Fluticasone propionate ointment, taccathitol ointment, yellow vaseline, and other drugs were also given topically. Following 2 weeks of treatment, the child's skin lesions resolved significantly with only slight pigmentation remaining and the Psoriasis Area and Severity Index (PASI) score decreased from 37.5 to 7.5 (PASI 75). Thereafter, 150 mg secukinumab was injected every 4 weeks until the last dose at 18 weeks (four more injections). After 18 weeks, the child's lesion resolved entirely (PASI 100), and no adverse effects were reported.

Biologics for the Management of Erythrodermic Psoriasis: An Updated Review

“…83 Its use in the management of EP has been reported in several case series [27][28][29][30][31][32] and case reports. [33][34][35][36][37][38]84 However, there are no clinical trials available. The largest case series has been reported by Damiani et al who reported the results of a multi-center, international, retrospective, pilot study enrolling 13 EP patients receiving secukinumab for 52 weeks.…”

“… 28 Of interest, two cases of pediatric EP successfully treated with secukinumab have been described. 37 , 38 …”

Effectiveness of Dialysis in Psoriasis: A Short Review

“…Psoriasis prevalence estimates on a global scale are being provided by an increasing number of populationbased research [32][33][34][35]. The prevalence of psoriasis varies around the globe.…”

Erythrodermic psoriasis after COVID-19 vaccination

“…1 EP following COVID-19 vaccination is more uncommon; Table I outlines reported cases. [3][4][5][6][7][8] Over one-half of these cases occurred following the Pfizer-BioNTech vaccine, one-half following the second dose, and three-fourths in males. The patient age ranged from 7 to 58 years old.…”

“…1,3,8,9 Cases have been reported after non-mRNA COVID-19 vaccines; therefore, the mRNA component is likely not responsible. 7,8 Other vaccinations have also reportedly caused psoriasis flares, including influenza (H1N1), tetanus-diphtheria, BCG Q5 , and pneumococcal pneumonia. 1 Although this case adds to the literature on psoriasis flares following COVID-19 vaccination, such cases are uncommon.…”