Linear psoriasis - a case report

Ustekinumab is effective in the treatment of linear psoriasis: a case report and literature review

Linear psoriasis is a rare type of psoriasis that usually presents as scaly papules and plaques unilaterally distributed along the Blaschko line. Currently, the pathogenesis of linear psoriasis is not fully understood, and genetic mosaicism may be one of the explanations. As linear psoriasis is less responsive to treatment than psoriasis vulgaris, there is no consensus on treatment guidelines specifically for this disease, and the efficacy of ustekinumab in treating this category has not been reported. In this article, we present a case of effective treatment of linear psoriasis with ustekinumab and review the relevant literature, hoping to help clinicians better understand and treat this disease.

Anti-tumor necrosis factor-alpha inhibitor-induced linear psoriasis: A case report

A 56-year-old male presented to the clinic for follow-up of severe, longstanding hidradenitis suppurativa. On physical examination, there was a linear Blaschkoid distribution of erythematous scaly papules extending from the left upper arm toward the scapular mid-back region. A clinical diagnosis of linear psoriasis was made, and the patient's dosage interval of infliximab was decreased to every 6 weeks. The patient was offered Betamethasone diproprionate/calcipotriol (Enstilar) topical foam to use daily which demonstrated efficacy in clearing 90% of the affected areas. This case illustrates the potential for Betamethasone diproprionate/calcipotriol (Enstilar) topical foam use as a treatment approach for anti-tumor necrosis factor-alpha inhibitor-induced linear psoriasis. At present there is no consensus on linear psoriasis pathogenesis or best treatment approach, therefore, more research is needed to understand its pathogenesis and establish management guidelines.

Adult-onset inflammatory linear verrucous epidermal nevus: Immunohistochemical studies and review of the literature

Adult-onset inflammatory linear verrucous epidermal nevus (ILVEN) is an uncommon cutaneous disease compared to childhood-onset ILVEN. The typical histopathologic features are alternating parakeratosis and orthokeratosis with an absent granular layer underneath parakeratosis, in contrast to a thickened granular layer below the foci of orthokeratosis in psoriasiform epidermal hyperplasia. Herein, we present a 49-year-old woman with typical clinical and histopathologic characteristics of adult-onset ILVEN, including linear arrangement of thick scaly papules and plaques localized on the medial side of her right leg, ankle, and foot. Immunohistochemical studies included involucrin, Ki-67, and keratin-10. Compared to the staining pattern in psoriasis, the expression of involucrin in this case was of lower intensity and localized to upper epidermal layers with relatively less extensive staining beneath regions of parakeratosis as compared to orthokeratosis; Ki-67 showed lower basal layer proliferative activity; and keratin-10 showed a greater intensity of staining within suprabasal epidermis.

Clinical and Therapeutic Aspects of Linear Psoriasis: A Study of 30 Cases

BACKGROUND

Psoriasis affects 2-4% of the population, with the most common clinical type being plaque psoriasis. The linear form of psoriasis is very rare. The literature on linear psoriasis (LP) consists of only case reports, and data are few.

OBJECTIVE

This study aimed to better understand LP in a large-scale study.

PATIENTS AND METHODS

We retrospectively retrieved the medical records from 14 French medical centers of patients newly diagnosed clinically with LP, with or without the support of histology, between 1 February and 31 July 2015. For each case, we assessed the clinical features, treatments and treatment efficacy.

RESULTS

In total, 30 cases of LP (mean age 26.8 years, 13 males) were reported. Mean age at onset of LP was 20.0 years, with 18 developing LP in childhood. Ten patients had a family history of psoriasis, and two had psoriatic arthritis. A total of 19 cases were linear at onset, with concomitant classical psoriasis; these were termed "superimposed" LP. The remaining 11 cases were not associated with classical psoriasis and were termed "isolated" LP. In four of the superimposed cases, LP developed when the patient was receiving systemic treatment: methotrexate (n = 2), etanercept (n = 1) or infliximab (n = 1). Topical steroids were effective in 76% of cases in which they were used, and systemic treatment was effective in < 66%. Treatments were less effective in LP than in classical psoriasis.

DISCUSSION

We identified a wide range of LP, with two profiles: isolated LP and superimposed LP. Topical treatment usually evoked clinical response, with relative resistance to systemic therapy. Methotrexate and anti-tumor necrosis factor (TNF)-α therapies can possibly unmask LP.

The Successful Treatment of a Case of Linear Psoriasis with Ixekizumab

Linear psoriasis is an unusual clinical variation of psoriasis that manifests segmentally along the lines of Blaschko. A major differential diagnosis is inflammatory linear verrucous epidermal nevus (ILVEN). The treatment of linear psoriasis is often challenging, with inadequate response to biological agents reported in the literature. We report a case of a 25-year-old African-American female who presented with asymptomatic hyperkeratotic papules along the lines of Blaschko and was subsequently diagnosed with linear psoriasis. After failing conventional treatment regimens, the patient received a trial of ixekizumab with complete resolution of cutaneous lesions reported after 4 months and only 8 doses of the anti-IL-17 biologic agent.

Isolated linear blaschkoid psoriasis

Linear psoriasis (LPs) is considered a rare clinical presentation of psoriasis, which is characterized by linear erythematous and scaly lesions along the lines of Blaschko. We report the case of a 20-year-old man who presented with asymptomatic linear and S-shaped erythematous, scaly plaques on right side of his trunk. The plaques were arranged along the lines of Blaschko with a sharp demarcation at the midline. Histological examination of a skin biopsy confirmed the diagnosis of psoriasis. Topical calcipotriol and betamethasone dipropionate ointments were prescribed for 2 months. A good clinical improvement was achieved, with reduction in lesion thickness and scaling. In patients with linear erythematous and scaly plaques along the lines of Blaschko, the diagnosis of LPs should be kept in mind, especially in patients with asymptomatic lesions of late onset.