Investigators Link Secukinumab to 2 Cases of Dyshidrotic Eczema in Patients With Psoriasis

Two documented cases of dyshidrotic eczema are linked to patients taking secukinumab for psoriasis, according to a case report published in SAGE Open Medical Case Reports.

Investigators from Ottawa, Canada reported their experience with 2 psoriasis patients who were treated with secukinumab and developed dyshidrotic eczema.

Secukinumab is described by the investigators as “a fully human recombinant IgG1K monoclonal antibody that is a specific antagonist of interleukin-17a,” which is regarded as the primary immune cell involved in the pathogenesis of psoriasis.

Secukinumab received FDA approval in January 2015 for the treatment of severe psoriasis, the study authors added. The agency has reported 12 cases of dyshidrotic eczema in patients taking secukinumab, although the information had not been previously published, they said. All of those cases occurred between 1 and 12 months after starting secukinumab.

Its most common side effects include nasopharyngitis, diarrhea, and upper respiratory tract infection, and cutaneous side effects include injection site reaction, oral herpes reactivation, and less frequently urticaria, the authors added. In patients with Crohn disease, flare ups were observed in clinical trials.

But in trials, secukinumab demonstrated the ability to effectively achieve disease control compared to other systemic therapies. As a new therapy, the authors said, long-term data is limited.

The first case was a 52-year-old female with severe guttate psoriasis since October 2016. She did not have a history of eczema but was treated with secukinumab after topical corticosteroid and vitamin D analogs. She did not take any other medications and initiated secukinumab on June 16, 2017.

After 8 months, she developed widespread eczema and dyshidrotic, vesiculobullous eruption located on her palms. She did not change occupations or personal skin care products prior to the eruption.

She discontinued secukinumab and started cyclosporine and guselkumab. After the subsequent weeks of the new treatment, her symptoms resolved and she did not have a dyshidrotic eczema recurrence. Her psoriasis remains stable, the investigators said.

The authors also reported on a second patient, a 69-year-old female with palmoplantar psoriasis and inflammatory arthritis, which was diagnosed 4 years prior. Other therapies were ineffective for varying reasons: she was recalcitrant to topical corticosteroids, she could not tolerate methotrexate, and she could only tolerate soriatane every other day.

After 7 weeks of secukinumab therapy, she developed a vesiculobullous and pompholyx-like eruption, the authors said. She discontinued the drug and started infliximab and apremilast to clear her lesions over the subsequent weeks and months.

The investigators report that her psoriasis remains stable and it is in remission. With permission, they also included photographs of each patient’s dyshidrotic eczema.

“The pathogenesis of DE is not well understood,” the study authors concluded. “It is a chronic, relapsing, spongiotic dermatosis belonging to the spectrum of eczema… Secukinumab is a newer treatment for psoriasis and not all adverse reactions are known. As more patients are prescribed this medication, for longer durations, other adverse reactions can be better characterized and managed.”

Reference

Bose R, Beeker J. Dyshidrotic eczema in two patients on secukinumab for plaque psoriasis: A case report [published online February 10, 2020]. SAGE Open Med Case Rep. doi: 0.1177/2050313X20904561.