Introduction
Psoriasis is a chronic immune-mediated skin disease that affects an estimated 125 million people worldwide[1]. Existing literatures mainly reviewed psoriasis flares following COVID-19 vaccination, but few touched on flares among their patients’ current therapy and flares after COVID-19 infection. Here, we first report a patient who developed worsen psoriasis shortly after COVID-19 infection, which was previously well controlled on secukinumab, and eventually successfully treated with adalimumab.
Case Report
A 62-year-old man, diagnosed as psoriasis vulgaris combined with coronary heart disease, had been well controlled on secukinumab (IL-17A inhibitor) since March 2022. Ten months later, the patient contracted the COVID-19 infection, but soon recovered in 2 days with a slight fever. However, erythema and scales gradually appeared on his trunk and limbs (Figure1. A-B), which showed no response to two consecutive doses of 300mg/month of secukinumab.
His blood tests revealed increased level of TNF, 9.98 pg/ml (normal value<8.10 pg/ml). While IL-6, C-reactive protein and erythrosedimentation rate were normal. Skin biopsy (Figure1. E-F) indicated a psoriasiform dermatitis. Combining the patient’s history of psoriasis, the disease was confirmed as psoriasis flare, and the rash subsided significantly after 8 weeks of adalimumab (TNF-α inhibitor) treatment (Figure1. C-D). The patient was still in follow-up.