Patient-oriented approach to prescribing systemic therapy for psoriasis with biologics: a case report

In recent decades, for the treatment of patients with moderate to severe psoriasis, biologics have been actively developed, the use of which is recommended when the psoriasis systemic treatment is insufficiently effective or if there are contrain dications to it. However, in recent years, experts have increasingly raised the question of the use of biologics at an early stage of the aggressive course of the disease, especially in cases where psoriasis causes significant psychosocial maladjustmentin the patient, problems with establishing interpersonal and social relationships, a feeling of stigmatization and a decrease in the quality of work. Palmoplantar psoriasis which is associated with great difficulties in daily and occupational life requires special attention in this regard.

The article presents a case report that shows of the successful early use of therapy with biologics in a patient to relieve symptoms of palmoplantar psoriasis and distal interphalangeal psoriatic arthritis which began in the early stages of the disease due to a significant decrease in the quality of life and work activity, as well as of an emphatic refusal of systemic basic therapy with methotrexate.

After a 4-week initial course of secukinumab, almost complete regression of psoriatic eruptions and symptoms of psoriatic arthritis was noted. The patient’s psychoemotional state has stabilized. Performing manipulations related to one’s occupational duties does not cause any difficulties due to the disease.

Biologics for the treatment of moderate and severe forms of the disease has become a major advance allowing not only to obtain a high level of therapeutic response but also to successfully correct the psychosocial consequences of the disease.

Russian clinical guidelines use a stepwise approach to the treatment of psoriasis. The first-line systemic therapy includes basic anti-inflammatory drugs – methotrexate, retinoids for the treatment of psoriasis, cyclosporine, ultraviolet irradiation of the skin. In the case of their ineffectiveness, intolerance or the presence of contraindications, prescribing biologics is considered. The presented case report demonstrates that the patient’s emphatic refusal of systemic basic therapy for psoriasis can also be considered as a possible reason for the early use of biologics which allows recovering both the physical and psychosocial status of the patient.

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