Ustekinumab-induced remission of recalcitrant guttate psoriasis: A case series

BSA: body surface area HLA: human leukocyte antigen IL: interleukin PGA: physician global assessment Th: T helper INTRODUCTION Guttate psoriasis is an acute, eruptive form of psoriasis characterized by small, scaly papules and plaques. The exact immunopathogenesis of guttate psoriasis is unclear. However, this subtype of psoriasis shares several features with plaque psoriasis, including an association with group A streptococcal infections and the human leukocyte antigen (HLA)C*06:02 allele. Although most cases of guttate psoriasis are self-limiting, more severe cases require treatment with topical steroids, phototherapy, or immunosuppressive medications. The use of biologic medications for the treatment of recalcitrant guttate psoriasis has not been systematically studied. The US Food and Drug Administration has approved ustekinumab, a monoclonal antibody against the shared p40 subunit of interleukin (IL)12 and IL-23, for the treatment of moderate-to-severe psoriasis, psoriatic arthritis, and Crohn’s disease. Its role in the treatment of guttate psoriasis has not been studied. Here we present a series of 6 patients (Table I) with recalcitrant guttate psoriasis who were treated successfully with ustekinumab, suggesting a potential role for this medication in the treatment of this psoriasis subtype.