مقاله انگلیسی رایگان در مورد درمان موفقیت آمیز پسوریازیس خطی با Ixekizumab – هینداوی 2017

Linear psoriasis is a rare clinical variation of psoriasis that manifests segmentally along the lines of Blaschko. The pathogenesis remains unclear, though some have proposed it could be explained by the well-established concept of genetic mosaicism [1]. Happle (1991) suggested that the loss of heterozygosity in somatic cells during early embryogenesis results in somatic recombination with daughter cells. Subsequently, these daughter cells go on to become clonal stem cells proliferating in a linear pattern during the embryonic development of the skin. A major differential diagnosis for linear psoriasis is inflammatory linear verrucous epidermal nevus (ILVEN), which also presents along the lines of Blaschko with similar morphology [2]. Psoriasis presenting in this manner is often mistaken for ILVEN and undertreated. The treatment of linear psoriasis can be challenging, with reports of inadequate clinical response to various biologic agents approved for the treatment of plaque psoriasis [3]. To our knowledge, we report the first case of this atypical psoriasis morphology successfully treated with the biologic agent ixekizumab.

2. Case Report

A 25-year-old African-American female presented to our clinic with asymptomatic lesions linearly arranged over her left upper extremity. The initial lesion first appeared fifteen years ago and new lesions gradually appeared over time. She denied joint pain and/or a history of infections prior to lesion development. Her past medical history was significant only for posttraumatic distress disorder and depression. There was no personal or family history of psoriasis or other dermatologic disease. Prior to presentation in our clinic, she had a skin biopsy of the right forearm which showed chronic spongiotic dermatitis with parakeratotic foci and superficial perivascular mononuclear infiltrates. No deep dermal or periadnexal infiltrates were seen and periodic acidSchiff staining was negative for fungal organisms. Based on the results, both lichen striatus and linear psoriasis were considered as potential diagnosis, and she was started on high-potency topical steroids. A month later, the patient was referred to our clinic when she failed to respond to treatment.