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Abstract: This article describes a 28-year-old male with previously diagnosed psoriasis, who was treated with irregular medication, resulting in recurrent disease. 1 week ago, he developed generalized erythema and scaling with pruritus and was admitted to the hospital, where he was diagnosed with erythrodermic psoriasis. Based on the exclusion of hepatitis and tuberculosis, the biologic agent skulchizumab injection was given for treatment. After 1 month of follow-up, the patient reported significant relief of pruritus and regression of skin lesions, and no adverse effects were observed.
Basic information】Male, 28 years old
Disease Type】Erythrodermic psoriasis
Hospital】Nanning Second People’s Hospital
Date of consultation】April 2022
Treatment plan】Biological agent treatment (secukizumab injection)
Treatment period】5 days of inpatient treatment, 1 week of outpatient follow-up
Effectiveness】The disease has been controlled and the symptoms have improved significantly.
I. Initial consultation
The patient, a 28-year-old male, complained of erythema, scaling and itching all over the body with no obvious cause 10 years ago, and had been diagnosed as psoriasis in an outside hospital. Since then, he was treated with irregular topical medication at home, and his condition improved but recurred. A few years ago, the skin began to appear flushed, and continued to be treated with irregular topical medication, but the condition was repeated and not treated. 1 week ago, the above symptoms worsened, and flushing and scaling appeared all over the body. Specialized examination: the skin of the whole body was dry and flushed, with a lot of flaking and bran-like, and the nails of both hands and toenails of both feet were yellow, dirty and broken.
II. Treatment process
The patient was admitted to the hospital to complete relevant examinations, three major routine, coagulation function, electrolytes, liver and kidney function, cardiac enzymology, four items before blood transfusion, three items of methyl work, tumor markers, three items of glycated hemoglobin, electrocardiogram, chest X-ray and other examinations did not see obvious abnormalities, and the pathology report of skin biopsy of the right calf was consistent with psoriasis changes. The patient’s diagnosis of erythrodermic psoriasis was clear, and her condition was poor under conventional conservative treatment in the past.
III. Treatment effect
The patient complained of significant relief of pruritus and skin lesions without adverse effects after 5 days of treatment with secukizumab injection, which can inhibit the release of pro-inflammatory cytokines and chemokines. After the specialized examination, the patient’s skin was flushed, but the color was lighter than before, the scales were reduced, and the nails of both hands and toenails were yellow, dirty and broken, so the patient was discharged. 1 week later, the patient was reexamined and the symptoms had been relieved, the pruritus was significantly reduced, and the scales and flushed skin were basically controlled.
IV. Notes
We are glad that the patient’s symptoms were basically relieved, but we still advise the patient to pay attention to good work and rest habits after discharge, avoid prolonged heavy physical work, avoid staying up late, pay attention to maintaining sufficient sleep; it is advisable to have a light diet, suggest the patient to have a low salt and low fat diet, eat more fresh vegetables and fruits, and participate in more outdoor activities to enhance physical fitness; in addition, we need to pay attention to keeping the skin clean and hygienic, avoid hot and cold stimulation and excessive scratching of the skin. If symptoms recur, patients should go to the hospital to review their condition.
V. Personal insight
In this case, the patient has a long history of irregular drug treatment, and her condition has repeatedly developed into erythrodermic psoriasis. For patients with erythrodermic psoriasis, in addition to paying attention to the lesions themselves and the multisystem damage, psychological interventions can be added if necessary to improve patients’ confidence. Then again, avoiding skin infections is especially crucial, which requires patients to pay attention to keeping the skin clean and dry and avoiding hand scratching of the ulcerated skin.
In addition, secukinumab is a humanized anti-IL-17A monoclonal antibody, and the latest Chinese guidelines for the treatment of psoriasis with biologic agents show that its clinical efficacy is remarkable, as well as its effectiveness in the treatment of erythrodermic psoriasis. As an injectable drug, secukizumab injection only needs to be injected at specific intervals, eliminating the need to take oral medication daily for a long period of time, which greatly increases patients’ compliance, and is fast-acting, effective, with few side effects and convenient, so more and more patients choose it as their first choice.