Secukinumab으로 치료 중인 건선 환자에서 발생한 역설적 아토피 습 진양 반응 1예

Abstract

Secukinumab is a humanized monoclonal antibody against IL-17A approved for psoriasis and psoriatic arthritis. Recently, various eczematous reactions associated with IL- 17 inhibitor were reported as the most common paradoxical reaction. Although its mechanism is not well known, blocking the Th1/Th17 pathway could induce a paradoxical Th2 axis activation, which manifests as atopic eczema. A 57-year-old female patient presented with 30-year lasting chronic plaque psoriasis on her scalp, trunk, and both extremities. She had a history of asthma and denied any personal or familial history of atopic dermatitis. Initially, the patient was treated with cyclosporine for 1 year followed by 6 months of methotrexate, but only a partial response was achieved. She started receiving secukinumab and after 3rd injection, psoriasis improved while developing severe pruritic eczematous eruption. Secukinumab was discontinued after the 5th injection due to eczema aggravation and systemic therapy with cyclosporine was started to manage the paradoxical eczematous reaction.