Successful Management of Ustekinumab-Induced Pustular Psoriasis without Therapy Discontinuation

We present a 34-year-old female patient with methotrexate unresponsive longstanding plaque psoriasis who developed pustular psoriasis ten weeks after initiation of ustekinumab therapy. Given the lack of other side effects and the rapid initial response of the underlying plaque psoriasis we opted against discontinuing ustekinumab therapy. Topical corticosteroids were added for the management of the pustular lesions on initial presentation. Given the treatment-resistant nature of our patient’s underlying plaque psoriasis, we chose dose-intense regimen (every 8 weeks). After successful remission of the pustular lesions, topical corticosteroids were discontinued. Following nearly complete clearance of the underlying plaque psoriasis, maintenance ustekinumab therapy at the recommended 12-week intervals was initiated starting week 28. No recurrence of pustular psoriasis was noted in our 18-month follow-up. Our experience shows that pustular lesions associated with ustekinumab can be successfully managed with topical corticosteroids without discontinuing ustekinumab therapy and compromising the therapeutic benefit seen with underlying condition.</p

Necrolytic migratory erythema: complete healing after surgical removal of pancreatic carcinoma

Necrolytic migratory erythema is considered an obligatory cutaneous paraneoplastic sign associated with glucagonoma. Glucagonoma syndrome is defined by the presence of an alpha-cell secreting tumor of the pancreas, elevated levels of glucagon, and a characteristic rash called necrolytic migratory erythema. Although necrolytic migratory erythema is a specific finding in glucagonoma syndrome, it may occur in other settings, unassociated with an alpha-cell pancreatic tumor (pseudoglucagonoma syndrome). The rarity of glucagonoma imposes a challenge, with most patients being diagnosed after a long period of treatment for their skin rash. The main prognostic sign of glucagonoma are the subsequent metastases that come late in the course of the disease. Herein, we present a 55-year-old female patient with a 5-year history of unrecognized cutaneous and systemic manifestations of glucagonoma syndrome. Based on the investigations, the diagnosis of glucagonoma syndrome without metastases was established. After surgical removal of pancreatic carcinoma/glucagonoma, complete healing and a long disease-free period was achieved. Appropriate awareness of the characteristics of necrolytic migratory erythema in physicians/dermatologists often leads to an early diagnosis of glucagonoma syndrome and enhances the chances of a favorable outcome.healing and long disease-free period was achieved. The awareness of physicians/dermatologists of the characteristic necrolytic migratory erythema, often leads to an early diagnosis of glucagonoma syndrome and enhance the chances of a favorable outcome.</p

Successful Management of Ustekinumab-Induced Pustular Psoriasis without Therapy Discontinuation

We present a 34-year-old female patient with methotrexate unresponsive longstanding plaque psoriasis who developed pustular psoriasis ten weeks after initiation of ustekinumab therapy. Given the lack of other side effects and the rapid initial response of the underlying plaque psoriasis we opted against discontinuing ustekinumab therapy. Topical corticosteroids were added for the management of the pustular lesions on initial presentation. Given the treatment-resistant nature of our patient’s underlying plaque psoriasis, we chose dose-intense regimen (every 8 weeks). After successful remission of the pustular lesions, topical corticosteroids were discontinued. Following nearly complete clearance of the underlying plaque psoriasis, maintenance ustekinumab therapy at the recommended 12-week intervals was initiated starting week 28. No recurrence of pustular psoriasis was noted in our 18-month follow-up. Our experience shows that pustular lesions associated with ustekinumab can be successfully managed with topical corticosteroids without discontinuing ustekinumab therapy and compromising the therapeutic benefit seen with underlying condition.</p