Received: 25 August 2016

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Revised: 2 February 2017

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Accepted: 9 March 2017

DOI: 10.1111/dth.12492

THERAPEUTIC HOTLINE: SHORT PAPERS

A dramatic response to a single dose of infliximab in a patient with prolonged pustular psoriasis derived from inverse psoriasis Mengmeng Li1 | Weiwei Dai2 | Wei Yan1 | Yuanzhen Liu1 | Lian Wang1 | Wei Li1 1 Department of Dermatovenereology, West China Hospital of Sichuan University, Chengdu, Sichuan, China 2

Department of Dermatovenereology, Chengdu University of Traditional Chinese Medicine Hospital, Chengdu, Sichuan, China Correspondence Wei Li, Department of Dermatovenereology, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan 610041, China. Email: [email protected]

Abstract We report a case of a 25-year-old Chinese man with an exceptionally prolonged history of pustular psoriasis derived from inverse psoriasis who was unsatisfied with conventional treatment and was successfully treated with a single dose of infliximab without noticeable adverse effects. No recurrence or flaring was observed after 3 months of follow-up. This case illustrates that infliximab may be an effective and safe therapeutic option for patients with refractory pustular psoriasis derived from inverse psoriasis. KEYWORDS

infliximab, inverse psoriasis, pustular psoriasis

1 | INTRODUCTION

acitretin. These medicines showed some improvement but were stopped for uncertain reasons, which led to flaring eruptions and dete-

Inverse psoriasis is a rare form of psoriasis that is characterized by the

rioration. Unfortunately, additional details of these treatments could

involvement of the flexural skin folds rather than the trunk and exten-

not be tracked. One month prior to admission, an upper respiratory

sor surfaces of the body. Usually, inverse psoriasis attacks the inguinal

infection triggered a deterioration in the patient’s eruptions, and

region, cleft, axillae and external genitalia instead of the scalp, lumbo-

numerous pustules erupted abruptly over the erythematous plaques of

sacral region and extensor extremities. Approximately 3–7% of patients

the bilateral inguen and axilla, resulting in severe pain (pain score: 8).

with psoriasis suffer from this type of disease (Wang, Li, Gao, & Liu,

These symptoms were accompanied by a fever of up to 38.28C. No

2005). However, to our knowledge, no patients with pustular psoriasis

family history of psoriasis was noted.

derived from inverse psoriasis have been reported. Here, we report a

A physical examination revealed the presence of 4 erythematous

case of unusually prolonged pustular psoriasis derived from inverse

plaques that were 2.0–3.0 cm in diameter in addition to scales on the

psoriasis in a young Chinese man who was unsatisfied with conven-

back and extensive erythematous patches with pustules over the bilat-

tional treatment and exhibited a dramatic improvement after a single

eral inguen, axilla and periumbilical area (Figure 1a). No scalp or nail

dose of infliximab therapy.

involvement was noted. Laboratory tests revealed the following: a leukocyte count of 9.69 3 109/L (normal range: 3.5–9.5 3 109/L), and a neutrophil count of 6.37 3 109/L (normal range: 1.8–6.3 3 109/L). Three major inflamma-

2 | CASE REPORT

tory biomarkers (including high-sensitivity C-reactive protein, hsCRP; A 25-year-old Chinese man presented with a longer than 6-year history

erythrocyte sedimentation rate, ESR; tumor necrosis factor alpha, TNF-a)

of erythematous and pruritic plaques with few scales located on skin

were all significantly elevated above normal levels (Table 1). The liver

fold areas, including the inguen, axillae, neck, perineum and perianal

function profile was also abnormal, with 84 IU/L of alanine amino-

region. The patient was admitted to our department due to the occur-

transferase (ALT) (normal range: