Treatment of paradoxical eczematous eruption in psoriasis treated with secukinumab: A case report

Rationale:Eczematous eruption is an increasingly recognized form of drug-related eruption, typically reported in association with interleukin 17 (IL-17)A inhibitors. However, severe paradoxical eczematous eruption due to IL-17A inhibitors has been rarely reported. Herein, we reported a case of a man with severe psoriasis with erythematous scaly plaques on the scalp, trunk, and arms and legs after the administration of secukinumab was initiated. Patient concerns:We reported a case of a 20-year-old man with severe psoriasis with erythematous scaly plaques on the scalp, trunk, and arms and legs after the administration of secukinumab was initiated. A skin biopsy was performed. It revealed spongiotic dermatitis consistent with eczematous reaction. Direct and indirect immunofluorescence assays were negative. Diagnoses:He was diagnosed with eczematous eruption. Interventions:Discontinuation of secukinumab and administration of cyclosporine and prednisone were considered. Outcomes:Significant improvement was observed, with no adverse events. Conclusion:Our case shows that eczematous eruption can paradoxically occur in patients on IL-17A inhibitors and this report is expected to increase awareness of the rising number of cutaneous eruptions related to biological agents.

Automated summary

A case of severe paradoxical eczematous eruption caused by IL-17A inhibitors was reported. A 20-year-old man with severe psoriasis developed erythematous scaly plaques on the scalp, trunk, and limbs after receiving secukinumab treatment. Skin biopsy revealed spongiotic dermatitis consistent with eczematous reaction. Discontinuation of secukinumab and administration of cyclosporine and prednisone resulted in significant improvement without adverse events. This case highlights the possibility of eczematous eruption in patients on IL-17A inhibitors and emphasizes the need for increased awareness of cutaneous eruptions related to biological agents.