Treatment of erythrodermic psoriasis

with biologics: A systematic review

Osward Y. Carrasquillo, MD, MPH,a Gabriela Pab
on-Cartagena, MD,b Leyre A. Falto-Aizpurua, MD,a
Marely Santiago-V
azquez, MD, Karina J. Cancel-Artau, BS,c Gabriel Arias-Berrios, MD,a and
a

Rafael F. Mart
ın-Garc
ıa, MDa

San Juan, Puerto Rico

Background: Biologic medications for plaque psoriasis have been used to treat erythrodermic psoriasis
(EP). Since the guidelines for management of EP were published, new biologic medications have been
approved for the treatment of plaque psoriasis.

Objective: To analyze the evidence of biologic medications in the treatment of EP based on response and
tolerability.

Methods: A comprehensive search was conducted with the PubMed, Cochrane Library, Embase, and
Scopus databases through December 31, 2018. Studies reporting 1 or more cases of EP, defined as
[75% body surface area involvement, in patients aged $18 years treated with biologics were included.
Baseline Psoriasis Area and Severity Index score, score improvement, and adverse events
were documented. Adequate response to treatment was defined as Psoriasis Area and Severity Index
$50.

Results: Included were 43 articles, yielding a total of 179 patients. Most patients responded at some point
during treatment, with a higher level of evidence for infliximab, ustekinumab, ixekizumab, and
guselkumab. Infection was the most common adverse event (n = 35).

Limitations: Data are limited to case reports, case series, and uncontrolled studies.

Conclusion: Patients with EP treated with biologics demonstrated positive responses and treatment was
well-tolerated, with a weak recommendation and limited quality of evidence in favor of infliximab,
ustekinumab, ixekizumab, and guselkumab. ( J Am Acad Dermatol 2020;83:151-8.)

Key words: adalimumab; biologics; erythrodermic psoriasis; etanercept; golimumab; guselkumab;

infliximab; ixekizumab; psoriasis; secukinumab; ustekinumab.

P soriasis is a chronic inflammatory condition of
the skin affecting approximately 2% of the
world’s population.1 Several clinically distinct
subtypes of psoriasis include chronic plaque psori-
asis, nail psoriasis, pustular psoriasis, erythrodermic
psoriasis (EP), and guttate psoriasis.2 EP is a rare and
severe variant with a prevalence of less than 3% of all
cases.3 This condition generally develops in patients
with poorly controlled psoriasis. Other factors that
may trigger EP are abrupt withdrawal of systemic
medications such as corticosteroids, drug reactions
to medications such as lithium, and underlying
systemic infections.4 EP is characterized by general-
ized erythema and scaling affecting more than 75% of
body surface area.3,5 Affected patients can present
numerous systemic symptoms such as fever, tachy-
cardia, lymphadenopathy, arthralgia, and fatigue.5
Without appropriate treatment, high-output cardiac

From the Department of Dermatologya and the Transitional Year
Program,b University of Puerto Rico School of Medicine; and
the University of Puerto Rico School of Medicine, San Juan.c
Funding sources: None.
Conflicts of interest: None disclosed.
IRB approval status: Not necessary for this systematic review due
to all the data being taken from public, anonymous literature.
Accepted for publication March 25, 2020.
Reprints are not available from the authors.
Correspondence to: Osward Y. Carrasquillo, MD, MPH, University
of Puerto Rico School of Medicine, Department of
Dermatology, PO Box 365067, San Juan, PR 00936-5067.
E-mail: ocarrasquillo5@gmail.com.
Published online April 2, 2020.
0190-9622/$36.00
Ó 2020 by the American Academy of Dermatology, Inc.
https://doi.org/10.1016/j.jaad.2020.03.073

151

Downloaded for ABDUL HAMEED (abdulhameed74@hotmail.com) at ClinicalKey Global Guest Users from ClinicalKey.com by Elsevier on June 25, 2020.
For personal use only. No other uses without permission. Copyright ©2020. Elsevier Inc. All rights reserved.
152 Carrasquillo et al J AM ACAD DERMATOL
JULY 2020

failure, malabsorption, anemia, and sepsis could review protocol is registered with PROSPERO
occur, resulting in increased morbidity, and in (CRD42019133413; https://www.crd.york.ac.uk/
some cases, death.2,3 prospero/).
Treatment can be very challenging. The latest
National Psoriasis Foundation Consensus Guidelines Study eligibility, selection criteria, and
recommend cyclosporine or infliximab as first-line screening
therapy due to their rapid onset of action. Independent assessment of the titles and abstracts
Other recommended first-line agents include was performed out inde-
acitretin and methotrexate.6 pendently by 2 of the
However, these recommen- authors (O.Y.C. and K.J.C.).
CAPSULE SUMMARY
dations were made before Disagreements were resolved
evidence of efficacy and through discussion with a
safety in the treatment of Biologic medications have been
d
third author (R.F.M.). All
EP was available for most demonstrated to have a positive studies reporting 1 or more
biologic agents recently response in the treatment of cases of EP treated with bi-
approved to treat psoriasis. erythrodermic psoriasis. ologics were included. EP was
Levin et al7 reviewed the Infliximab, ustekinumab, guselkumab,
d
defined as [75% of body sur-
safety and efficacy of usteki- and ixekizumab should be considered face area involvement with
numab, adalimumab, etaner- first-line biologic agents in the treatment inflammatory erythema and
cept, and infliximab in the of acute and severe flares of scaling at baseline. The
treatment of EP. Since then, erythrodermic psoriasis, whereas following criteria were used
additional biologic medica- etanercept and adalimumab should be to exclude articles: pediatric
tions, such as ixekizumab, considered as second-line agents. patients (\18 years), \75% of
secukinumab, and guselku- body surface area involve-
mab, have been approved ment, erythroderma caused
for the treatment of moderate to severe plaque by a condition other than psoriasis, patient was treated
psoriasis. with biologics for a different condition that was not EP,
In this study, we perform a systematic review to or article failed to mention response to treatment. If the
determine the response and tolerability of biologic full text was not available online, it was ordered at the
medications used in the treatment of EP, including University of Puerto Rico School of Medicine library.
adalimumab, etanercept, infliximab, ixekizumab,
golimumab, guselkumab, secukinumab, and usteki- Data extraction and statistical analysis
numab, and make treatment recommendations The following variables were gathered as
based on level of evidence, onset of action, adverse available: age, sex, body mass index, duration of
effects, and sustained response with these disease, comorbidities, prior therapies, adjuvant
medications. treatments, Psoriasis Area and Severity Index (PASI)
score, total follow-up time, PASI score improvement,
MATERIALS AND METHODS and adverse events (AEs). Adequate response to
Search strategy treatment was defined as PASI $50. Statistical
This review was performed in accordance with analysis was done using IBM SPSS 25 software
the Preferred Reporting Items for Systematic Reviews (IBM, Armonk, NY).
and Meta-Analyses.8 A primary literature search was
conducted with the databases PubMed, Scopus, Risk of bias, level of evidence, and grade of
Embase, and Cochrane Library. We identified eligible recommendation assessment
articles from database inception to December 31, Owing to the nature of the condition, we did not
2018. The search terms were ‘‘biologics’’ and expect to find comparative studies. To assess the risk
‘‘erythrodermic psoriasis,’’ ‘‘biologic’’ and ‘‘erythro- of bias of studies, we used a tool developed by Haffar
dermic psoriasis,’’ ‘‘(drug name)’’ and ‘‘erythroder- et al9 derived from the Newcastle Ottawa scale.10
mic psoriasis.’’ Drug names included secukinumab, This tool has been used previously.9,11-14 It consists
ixekizumab, golimumab, guselkumab, infliximab, of 5 criteria in the form of questions with a binary
etanercept, ustekinumab, and adalimumab. Articles response (yes/no) to indicate whether the item is
written in Spanish and English were included. suggestive of bias. The tool is composed of the
There were no limitations on article type. After the following questions:
selection process, the references of all included 1. Did the patient(s) represent the whole case(s)
articles were assessed for missing publications. The of the medical center?

Downloaded for ABDUL HAMEED (abdulhameed74@hotmail.com) at ClinicalKey Global Guest Users from ClinicalKey.com by Elsevier on June 25, 2020.
For personal use only. No other uses without permission. Copyright ©2020. Elsevier Inc. All rights reserved.
J AM ACAD DERMATOL
VOLUME 83, NUMBER 1
Abbreviations used:
AE: Adverse event
EP: erythrodermic psoriasis
PASI: Psoriasis Area and Severity Index
2. Was the diagnosis correctly made?
3. Were other important diagnoses excluded?
4. Were all important data cited in the report?
5. Was the outcome correctly ascertained?
Quality of the report was considered good (low
risk of bias) when all 5 criteria were fulfilled,
moderate (moderate risk of bias) when 4 were
fulfilled, and poor (high risk of bias) when #3
were fulfilled. Two of the authors (O.Y.C. and G.P.)
assessed the risk of bias of the studies with
discussion with a third author (R.F.M.) in case of
disagreement.
Recommendations for each biologic were given
based on criteria by Robinson and colleagues.15
RESULTS
Systematic search results
We included 43 articles yielding 179 patients with
EP treated with biologic medications (Fig 1). Case
reports comprised 65.1% of the articles, followed by
case series (14.0%) and open-label studies (11.6%).
There were 3 retrospective studies and 1 open
prospective study. Sixteen articles reported treat-
ment with infliximab,16-31 10 with ustekinumab,32-41
4 with etanercept,42-45 5 with secukinumab,46-50 and
3 with adalimumab.51-53 Ixekizumab,54 golimu-
mab,55 and guselkumab56 were each found in 1
study. One article reported patients treated with
infliximab, adalimumab, etanercept, or ustekinu-
mab, and another article reported patients treated
with infliximab or etanercept.57,58
Description of patients
The mean age at presentation was 46.4 years, with
a male-to-female ratio of 3.6:1. Table I summarizes
the baseline characteristics of patients. An
assessment of all of the selected articles showed
the most common medications reported were
ustekinumab and infliximab, with 54 and 41 patients,
respectively.16-41,58 They were followed by
secukinumab (n = 19), etanercept (n = 14), guselku-
mab (n = 11), ixekizumab (n = 8), adalimumab
(n = 3), and golimumab (n = 1).42-56,58 One article
described 42 flares in 28 patients treated with
multiple biologic agents (infliximab, adalimumab,
etanercept, and ustekinumab) but was not included
in the analysis because data for individual patients
Downloaded for ABDUL HAMEED (abdulhameed74@hotmail.com) at ClinicalKey Global Guest Users from ClinicalKey.com by Elsevier on June 25, 2020.
For personal use only. No other uses without permission. Copyright ©2020. Elsevier Inc. All rights reserved.
Carrasquillo et al 153
could not be extracted.57 Supplemental Table I
(available via Mendeley at https://doi.org/10.
17632/dk7f9m4jbc.2) provides a summary of the
studies where EP was treated with biologics and
the risk of bias assessment.
Efficacy
Most patients showed adequate response in their
condition at some point during treatment interven-
tion. Of 122 patients that reported PASI scores after
treatment with biologics, 9.0% of patients failed to
achieve PASI 50.26,34,39,46 In a multicenter retrospec-
tive study with multiple biologics, Viguier et al57
reported PASI 75 at 10 to 14 weeks in 40% of those
treated with infliximab and equal improvement in
67%, 67%, and 0% of patients treated with etanercept,
adalimumab, and ustekinumab, respectively. A
smaller proportion of patients maintained PASI 75
at weeks 22 to 24 (infliximab, 20%; etanercept, 50%;
and adalimumab, 60%). Below we provide a
summary of the efficacy of each biologic medication
in the treatment of EP based on reduction of PASI
score. The study by Viguier et al57 was excluded from
the following analysis because they reported flares
instead of patients, and thus, we were unable to
extract the individual data from the study.
Recommendations for each biologic are provided
in Table II.16-58
Secukinumab. Of 19 patients who were admin-
istered secukinumab, 16 responded to treatment,
and 4 of 8 patients who reported improvement
between weeks 2 and 6 achieved PASI 75.47-49 One
of these patients demonstrated continuous improve-
ment and reached PASI 100 by weeks 8 to 12. Two
additional patients showed PASI 100 within this time
frame.47,50 Mateu-Puchades et al48 also reported PASI
scores during weeks 16 to 20, with 5 of 5 patients
reaching PASI 90. Weng et al46 described that 70% of
patients responded to treatment, showing evident
clearing of psoriasis (PASI[ 75) by week 16. One of
these patients experienced relapse by week 24. Two
patients demonstrated a sustained response after
approximately 6 months.46
Infliximab. Forty-one patients were treated
with infliximab. No PASI score was reported for
17 patients, but marked improvement of erythro-
derma was described 2 weeks after infliximab
infusion.20,22-25,31 One patient evaluated using a
modified PASI score achieved a significant
response.18 In a study by Torii et al,27 8 patients
were treated with infliximab, and the median PASI
improvement reported was 67.9% at week 10. Thus,
we were unable to assess whether any patient
from the that study did not respond to therapy.
Arroyo-Tridico et al17 reported a patient who
154 Carrasquillo et al J AM ACAD DERMATOL
JULY 2020

Fig 1. Study selection flow diagram.

Table I. Baseline characteristics of patients with Etanercept. Fourteen patients were treated with
erythrodermic psoriasis treated with biologic etanercept. One patient did not report PASI scores
medications but described significant improvement; neverthe-
Total reported
less, this patient relapsed during therapy.42 PASI
Characteristic patients, No. Value scores for 12 patients were reported on weeks 8 to
Age at presentation, mean y 174 46.4 12: 7 achieved PASI $75, 3 achieved PASI 50, and 2
Psoriasis duration, mean y 140 17.2 did not respond.44,45,58 Romero-Mate et al43 reported
Male sex, No. (%) 171 134 (78.4) a patient with PASI 100 over 34 months.
Body mass index, mean kg/cm2 68 24.8 Ustekinumab. Fifty-four patients were adminis-
Baseline PASI score, mean 152 40.5 tered ustekinumab, and 16 reported PASI score
Total follow-up, mean mo 135 12.3 improvement at weeks 2 to 6. Although 8 of these
patients were not responsive during that time frame,
PASI, Psoriasis Area and Severity Index.
all except 1 of the patients eventually responded to
therapy.32,33,38-40 There were 44 of 46 patients
with PASI $50 16 to 24 weeks after starting
maintained PASI 100 for 11 years. Another study medication.33-36,39,41 One patient did not respond
reported more than 90% improvement at week 6 in to treatment, and another patient initially responded
all 7 patients but did not specify which instrument but relapsed 28 weeks after intervention.39,41
was used to measure this response.19 Six other Another patient reported PASI $90 at week 114 of
studies reported significant improvement in 10 treatment.37 Only 7.4% of patients failed to respond
patients by weeks 2 to 12 (PASI $75).16,21,28-30,58 to treatment.34,39,41
Poulalhon et al26 reported PASI score-based Ixekizumab. Eight patients were treated with
outcomes by week 14: 3 patients achieved PASI ixekizumab as part of an open-label study. By
$75 and 2 patients did not respond.26 week 12, all patients achieved PASI 75, 5 of 8
Adalimumab. Only 3 patients received adalimu- achieved PASI 90, and 2 of 8 achieved PASI 100. By
mab for EP. One patient showed remission at week 3 week 24, 100% of patients reached PASI 75, 7 of 8
and the other 2 at week 12. PASI scores were not reached PASI 90, and 1 of 8 reached PASI 100. PASI
reported.51-53 scores were sustained by week 52.54

Downloaded for ABDUL HAMEED (abdulhameed74@hotmail.com) at ClinicalKey Global Guest Users from ClinicalKey.com by Elsevier on June 25, 2020.
For personal use only. No other uses without permission. Copyright ©2020. Elsevier Inc. All rights reserved.
J AM ACAD DERMATOL Carrasquillo et al 155
VOLUME 83, NUMBER 1

Table II. Assessment of level of evidence and grade of recommendation by biologic medication
Level of Grade of
Biologic evidence recommendation Source
Secukinumab 4 2B Weng et al,46 Mateu-Puchades et al,48 Mugheddu et al47
5 2B Galluzzo et al,49 Rongioletti et al50
Ustekinumab 3 2A Pescitelli et al34
4 2B Wang et al,39 Concha-Garzo
n et al41
5 2B Saraceno et al, Stinco et al,33 Kim et al,35 Koutsoukou et al,36
32

Castin~eiras et al,37 Santos-Juanes et al,38 Errichetti et al40

Infliximab 5 2B
4 2B
3 2A
Ixekizumab 3 2A
Adalimumab 5 2B
Etanercept 5 2B
3 2A
Golimumab 5 2B
Guselkumab 3 2A
Multiple biologics 3 2A
Arroyo-Tridico et al,17 Rongioletti et al,18 Takahashi et al,19 Lisby et al,20
O’Quinn et al,22 Fiehn et al,23 Lewis et al,24 Kurokawa et al,28
Belinchon et al,29 Yip et al,30 Su
arez Pedreira et al,31 Sahel et al58
Yip et al,21 Heikkil€a et al25
Valdes et al,16 Poulalhon et al,26 Torii et al27
Saeki et al54
Mumoli et al,51 Richetta et al,52 Vidal et al53
Talat et al,42 Romero-Mat
e et al,43 Pique-Duran et al,45 Sahel et al58
44
Esposito et al
Won-Ku Lee et al55
Sano et al56
Viguier et al57

Golimumab. One patient was treated with goli-
mumab and responded to treatment by week 4 and
continued to improve with PASI $75 by week 12.55
Guselkumab. Guselkumab was reported in 11
patients and all responded. By week 8, all patients
achieved PASI [50. At 52 weeks after treatment, 10
patients demonstrated sustained responses (mean
PASI $75), and 1 patient was lost to follow-up.56
Safety
There were 60 AEs (37.3%) reported secondary to
biologic therapy among studies that recorded their
occurrence. Infectious events (35 of 60) were
the most common. Further details can be found in
Table III.
DISCUSSION
We aim to update the recommendations for
treating EP with biologics published by Levin et al7
in 2012. Since their publication, new biologics have
been approved for the treatment of plaque psoriasis.
There is a lack of randomized, double-blind,
controlled trials and head-to-head comparisons.
Therefore, recommending any of the biologics as a
first-line treatment for the management of EP is a
challenge. Recommendations for each biologic are
presented in Table II. Overall, ustekinumab was the
most frequent biologic reported. It demonstrated a
slower onset of action than infliximab. Nevertheless,
patients treated with this medication reported long-
term clinical improvement (follow-up period range,
3-29 months) with few AEs. These findings support
the important role of interleukin (IL) 12 and IL-23
inflammatory pathways in the pathogenesis of EP.33
As reported by Stinco et al,33 ustekinumab seems to
be a promising candidate for the long-term control of
EP, especially when taking into consideration the
well-known possibility of developing tachyphylaxis
while on infliximab.7
The second most common biologic used was
infliximab, demonstrating excellent efficacy with
few serious AEs that cannot be fully attributed to
the medication. The drug had a rapid onset of
action, with responses achieved as early as 48 hours
after initiation of treatment.22,24 Most patients
demonstrated sustained improvement after 6 to
10 weeks.17,20,21,26-28 Infliximab was used in
combination with methotrexate or acitretin in several
studies, but these patients failed to respond faster
than those on monotherapy.17,19-21,25,27 For these
reasons, we agree with Rosenbach et al6 and Levin
et al,7 who suggested that infliximab should be
considered a first-line therapeutic agent in the
treatment of patients with acute, severe, or unstable
EP.6
Secukinumab, an IL-17A inhibitor, was adminis-
tered to 19 patients, of whom 84.2% showed
improvement by $8 weeks with no significant
AEs.46-48,50 However, 31.6% of patients suffered a
relapse. Weng et al46 attributed these recurrences to
history of prior biologic failure in their patients.
Although this may be a possibility, a proportion of
the patients responsive to such agents had also
been previously treated with alternate biologic

Downloaded for ABDUL HAMEED (abdulhameed74@hotmail.com) at ClinicalKey Global Guest Users from ClinicalKey.com by Elsevier on June 25, 2020.
For personal use only. No other uses without permission. Copyright ©2020. Elsevier Inc. All rights reserved.
156 Carrasquillo et al J AM ACAD DERMATOL
JULY 2020

Table III. Adverse effects reported in patients treated with biologics for erythrodermic psoriasis
Biologic Adverse event descriptions (n)
Secukinumab Hair repigmentation (1)
Ustekinumab Sudden death (1), furunculosis (1), widespread skin Staphylococcus aureus colonization (1), widespread
Staphylococcus epidermidis colonization (1), pulmonary miliary tuberculosis (1)
Infliximab ANA 1 serology (6), nasopharyngitis (3), infusion reaction (1), anaphylaxis (1) malaise (1), ductal cell
carcinoma (1), increased blood pressure (1), abnormal liver function test results (2), depression with
suicide attempt (1), sepsis secondary to Staphylococcus aureus (1), erysipelas (1), myocardial infarction
(1)
Ixekizumab Infection (6), hypersensitivity reaction (2), hepatic steatosis (1)
Adalimumab Unclassified T-cell lymphoma (1)
Etanercept Folliculitis (1), sepsis secondary to furunculosis (1), URTI (1), pruritus (1), UTI (1), pneumonia (1),
Staphylococcus aureus septicemia (1)
Golimumab None
Guselkumab Treatment-emergent infections (9), nasopharyngitis (4), gastroenteritis (1), nausea (1), arthralgia (1), rib
fracture (1)

ANA, Antinuclear antibody; URTI, upper respiratory tract infection; UTI, urinary tract infection.

medications. This implies that another mechanism
could be responsible for relapses after treatment
with secukinumab. Given its high relapse rate, we
recommend using secukinumab as second-line
therapy for EP based on individual patient
characteristics.
Most patients treated with etanercept and adali-
mumab responded to therapy. Nevertheless, it is
important to mention that 21 and 18 patients,
respectively, who received other biologics reported
prior failure to etanercept or adalimumab.
Etanercept was discontinued in some patients mainly
due to its lack of efficacy and AEs.44,57 Consequently,
we recommend considering etanercept and
adalimumab as second-line treatments for EP.
Guselkumab (IL-23 inhibitor) and ixekizumab
(IL-17 inhibitor) achieved significant improvement
after 52 weeks of follow-up.54 Minor infections were
a common AEs of both medications. However, it is
important to note that these studies had longer
follow-up periods compared with most case reports
and case series that reported the response of other
biologics. Because of their level of evidence,
guselkumab and ixekizumab can both be considered
first-line treatments for EP.
Regardless of which medication is eventually
selected for the treatment of EP, adjuvant measures,
including medium-potency topical steroids, moistur-
izers, wet dressings, oatmeal baths, and continued
supportive care are important.6
Unfortunately, data are limited to case reports,
case series, and uncontrolled studies. This could
contribute to publication bias, as evidenced by the
risk of bias assessment in which most studies had a
moderate risk of bias. Furthermore, recommending a
specific medication is difficult, and despite the
suggested therapies, it is important to treat every
patient on an individual basis.
CONCLUSION
Biologic therapy in patients with EP seems to be
well-tolerated and demonstrated a positive
response. Recommendations for biologic agent
therapy in EP are based on limited evidence. We
recommend infliximab or ustekinumab in acute,
severe cases of EP as first-line biologic agents. IL-23
and IL-17 inhibitor agents seem to be a promising
category of biologic treatment of EP and can also be
considered as first-line therapy based on their level
of evidence. Etanercept and adalimumab can be
used in milder, biologically na€ıve patients. Therapy
for patients with EP should be individualized and
based on each patient’s disease characteristics,
history of previous therapies, and comorbidities.
Increased understanding of pathogenic mechanisms
in EP and the continued development of newer
biologic agents for the treatment of psoriasis will
contribute to improve the quality of life in these
seriously affected patients.
REFERENCES
1. Christophers E. Psoriasisdepidemiology and clinical spectrum.
Clin Exp Dermatol. 2001;26(4):314-320.
2. Ladizinski B, Lee KC, Wilmer E, Alavi A, Mistry N, Sibbald RG. A
review of the clinical variants and the management of
psoriasis. Adv Skin Wound Care. 2013;26(6):271-284.
3. Lebwohl M. Psoriasis. Lancet. 2003;361:1197-1204.
4. Raychaudhuri SK, Maverakis E, Raychaudhuri SP. Diagnosis and
classification of psoriasis. Autoimmun Rev. 2014;13(4-5):490-495.
5. Singh RK, Lee KM, Ucmak D, et al. Erythrodermic psoriasis:
pathophysiology and current treatment perspectives. Psoriasis
(Auckl). 2016;6:93-104.
6. Rosenbach M, Hsu S, Korman NJ, et al. Treatment of
erythrodermic psoriasis: from the medical board of the

Downloaded for ABDUL HAMEED (abdulhameed74@hotmail.com) at ClinicalKey Global Guest Users from ClinicalKey.com by Elsevier on June 25, 2020.
For personal use only. No other uses without permission. Copyright ©2020. Elsevier Inc. All rights reserved.
J AM ACAD DERMATOL
VOLUME 83, NUMBER 1
National Psoriasis Foundation. J Am Acad Dermatol. 2010;62(4):
655-662.
7. Levin EC, Debbaneh M, Koo J, Liao W. Biologic therapy in
erythrodermic and pustular psoriasis. J Drugs Dermatol. 2014;
13(3):342-354.
8. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting
items for systematic reviews and meta-analyses: the PRISMA
statement. Open Med. 2009;3:e123-e130.
9. Haffar S, Bazerbachi F, Prokop L, Watt KD, Murad MH, Chari ST.
Frequency and prognosis of acute pancreatitis associated with
fulminant or non-fulminant acute hepatitis A: a systematic
review. Pancreatology. 2017;17(2):166-175.
10. Wells G, Shea B, O’Connell D, et al. The Newcastle-Ottawa scale
(NOS) for assessing the quality of nonrandomized studies in
meta-analysis. Ottawa, Ontario: The Ottawa Health Research
Institute, 2011.
11. Bazerbachi F, Haffar S, Szarka LA, et al. Secretory diarrhea and
hypokalemia associated with colonic pseudo-obstruction: a
case study and systematic analysis of the literature.
Neurogastroenterol Motil. 2017;29(11).
12. Bazerbachi F, Sawas T, Vargas EJ, et al. Metal stents versus
plastic stents for the management of pancreatic walled-off
necrosis: a systematic review and meta-analysis. Gastrointest
Endosc. 2018;87(1):30-42.
13. Bazerbachi F, Leise MD, Watt KD, Murad MH, Prokop LJ,
Haffar S. Systematic review of mixed cryoglobulinemia
associated with hepatitis E virus infection: association or
causation? Gastroenterol Rep. 2017;5:178-184.
14. Bazerbachi F, Haffar S, Hussain MT, et al. Systematic review of
acute pancreatitis associated with interferon-a or pegylated
interferon-a: possible or definitive causation? Pancreatology.
2018;18(7):691-699.
15. Robinson JK, Dellavalle RP, Bigby M, Callen JP. Systematic
reviews: grading recommendations and evidence quality. Arch
Dermatol. 2008;144(1):97-99.
16. Mar
ıa Del Pilar Vald
es A, Francisca Schroeder H, Vicky
Roizen G, Juan Honeyman M, Leonardo S
anchez M. Efficacy
of infliximab in patients with moderate and severe psoriasis
treated with infliximab (Remicade) [in Spanish]. Rev Med Chil.
2006;134(3):326-331.
17. Arroyo-Tr
ıdico L, Antonio JR, Mathias CE, Pozetti EMO.
Effectiveness and safety of infliximab for 11 years in a patient
with erythrodermic psoriasis and psoriatic arthritis. An Bras
Dermatol. 2017;92(5):743-745.
18. Rongioletti F, Borenstein M, Kirsner R, Kerdel F. Erythrodermic,
recalcitrant psoriasis: clinical resolution with infliximab. J
Dermatolog Treat. 2003;14(4):222-225.
19. Takahashi MD, Castro LG, Romiti R. Infliximab, as sole or
combined therapy, induces rapid clearing of erythrodermic
psoriasis. Br J Dermatol. 2007;157(4):828-831.
20. Lisby S, Gniadecki R. Infliximab (Remicade) for acute, severe
pustular and erythrodermic psoriasis. Acta Derm Venereol.
2004;85(3):247-248.
21. Yip L, Harrison S, Foley P. From biologic to biologic to biologic:
lessons to learn for erythrodermic and recalcitrant
chronic plaque psoriasis. Australas J Dermatol. 2008;49(3):
152-155.
22. O’Quinn RP, Miller JL. The effectiveness of tumor necrosis
factor alpha antibody (infliximab) in treating recalcitrant
psoriasis: a report of 2 cases. Arch Dermatol. 2002;138(5):644-
648.
23. Fiehn C, Andrassy K. Case number 29: hitting three with one
strike: rapid improvement of psoriatic arthritis, psoriatic
erythroderma, and secondary renal amyloidosis by treatment
with infliximab (Remicade). Ann Rheum Dis. 2004;63(3):232.
Downloaded for ABDUL HAMEED (abdulhameed74@hotmail.com) at ClinicalKey Global Guest Users from ClinicalKey.com by Elsevier on June 25, 2020.
For personal use only. No other uses without permission. Copyright ©2020. Elsevier Inc. All rights reserved.
Carrasquillo et al 157
24. Lewis TG, Tuchinda C, Lim HW, Wong HK. Life-threatening
pustular and erythrodermic psoriasis responding to infliximab.
J Drugs Dermatol. 2006;5(6):546-548.
25. Heikkil€a H, Ranki A, Cajanus S, Karvonen SL. Infliximab com-
bined with methotrexate as long-term treatment for eryth-
rodermic psoriasis. Arch Dermatol. 2005;141(12):1607-1610.
26. Poulalhon N, Begon E, Lebb
e C, et al. A follow-up study in 28
patients treated with infliximab for severe recalcitrant psori-
asis: evidence for efficacy and high incidence of biological
autoimmunity. Br J Dermatol. 2007;156(2):329-336.
27. Torii H, Nakagawa H. Long-term study of infliximab in
Japanese patients with plaque psoriasis, psoriatic arthritis,
pustular psoriasis and psoriatic erythroderma. J Dermatol.
2011;38(4):321-334.
28. Kurokawa R, Hagiwara A, Niijima Y, Kojima K. Computed
tomography imaging findings in erythrodermic psoriasis
treated with infliximab: a case report. Radiol Case Rep. 2018;
13(2):460-463.
29. Belinchon I, Lucas A, Ballester I, Betlloch I, P
erez-Crespo M.
Successful treatment of life-threatening erythrodermic psori-
asis with infliximab. J Am Acad Dermatol. 2009;60(3):AB171.
30. Yip L, Harrison S, Foley P. Infliximab rescue of efalizumab
withdrawal flare and psoriasis-precipitated depression. Aus-
tralas J Dermatol. 2008;49(4):250-251.
31. Su
arez Pedreira I, Santos Juanes J, Caminal Montero L,
Trapiella L. Infliximab: an alternative in refractory erythroder-
mic psoriasis. Piel. 2006;21(6):317-318.
32. Saraceno R, Talamonti M, Galluzzo M, Chiricozzi A, Costanzo A,
Chimenti S. Ustekinumab treatment of erythrodermic psoriasis
occurring after physical stress: a report of two cases. Case Rep
Dermatol. 2013;5(3):254-259.
33. Stinco G, Piccirillo A, Errichetti E, Bergamo S, Patrone P.
Treatment of recalcitrant erythrodermic psoriasis with usteki-
numab. Eur J Dermatol. 2014;24(3):387-390.
34. Pescitelli L, Dini V, Gisondi P, et al. Erythrodermic psoriasis
treated with ustekinumab: an Italian multicenter retrospective
analysis. J Dermatol Sci. 2015;78(2):149-151.
35. Kim YS, Kim HJ, Lee S, Park YL. Erythrodermic psoriasis
improved by ustekinumab: a report of two cases. Ann
Dermatol. 2016;28(1):121-122.
36. Koutsoukou XA, Papadavid E, Theodoropoulos K,
Rigopoulos D. Ustekinumab in severe complicated erythro-
dermic psoriasis: rapid clearing, safety, and sustained remis-
sion. Dermatol Ther. 2014;27(5):257-259.
37. Casti~neiras I, Fern
andez-Diaz L, Ju
arez Y, Lueiro M. Sustained
efficacy of ustekinumab in refractory erythrodermic psoriasis
after failure of antitumor necrosis factor therapies. J Dermatol.
2012;39(8):730-731.
38. Santos-Juanes J, Coto-Segura P, Mas-Vidal A, Galache Osuna C.
Ustekinumab induces rapid clearing of erythrodermic psoriasis
after failure of antitumour necrosis factor therapies. Br J
Dermatol. 2010;162(5):1144-1146.
39. Wang TS, Tsai TF. Clinical experience of ustekinumab in the
treatment of erythrodermic psoriasis: a case series. J Dermatol.
2011;38(11):1096-1099.
40. Errichetti E, Piccirillo A. Latent tuberculosis reactivation in a
patient with erythrodermic psoriasis under treatment with
ustekinumab and a low dose steroid, despite isoniazid
chemoprophylaxis. Eur J Dermatol. 2014;24(4):508-509.
41. Concha-Garz
on MJ, Godoy-Trapero A, Daud
en E, et al. Short-
and long-term treatment of erythrodermic psoriasis with
ustekinumab: a national and multicenter case series. J Am
Acad Dermatol. 2014;70(5):AB189.
42. Talat H, Wahid Z, Feroz F, Sajid M. Erythrodermic psoriasis and
hepatitis C infection treated with pegylated interferon and
158 Carrasquillo et al
anti-TNFa a(etanercept) therapy. J Coll Physicians Surg Pak.
2017;27(9):S77-S79.
43. Romero-Mat
e A, Garc
ıa-Donoso C, Martinez-Mor
an C, Hern
an-
dez-N
un~ez A, Borbujo J. Long-term management of
erythrodermic psoriasis with anti-TNF agents. Dermatol Online
J. 2010;16(6):15.
44. Esposito M, Mazzotta A, de Felice C, Papoutsaki M, Chimenti S.
Treatment of erythrodermic psoriasis with etanercept. Br J
Dermatol. 2006;155(1):156-159.
45. Piqu
e-Duran E, P
erez-Cejudo JA. Psoriatic erythroderma
treated with etanercept [in Spanish]. Actas Dermosifiliogr.
2007;98(7):508-510.
46. Weng HJ, Wang TS, Tsai TF. Clinical experience of
secukinumab in the treatment of erythrodermic psoriasis: a
case series. Br J Dermatol. 2018;178(6):1439-1440.
47. Mugheddu C, Atzori L, Lappi A, Pau M, Murgia S, Rongioletti F.
Successful secukinumab treatment of generalized pustular
psoriasis and erythrodermic psoriasis. J Eur Acad Dermatol
Venereol. 2017;31(9):e420-e421.
48. Mateu-Puchades A, Santos-Alarco
n S, Martorell-Calatayud A,
Pujol-Marco C, S
anchez-Carazo JL. Erythrodermic psoriasis and
secukinumab: our clinical experience. Dermatol Ther. 2018;
31(4):e12607.
49. Galluzzo M, D’Adamio S, Campione E, Mazzilli S, Bianchi L,
Talamonti M. A clinical case of severe disease burden: an
erythrodermic psoriatic patient treated with secukinumab. J
Dermatolog Treat. 2018:1-11.
50. Rongioletti F, Mugheddu C, Murgia S. Repigmentation and
new growth of hairs after antieinterleukin-17 therapy
Downloaded for ABDUL HAMEED (abdulhameed74@hotmail.com) at ClinicalKey Global Guest Users from ClinicalKey.com by Elsevier on June 25, 2020.
For personal use only. No other uses without permission. Copyright ©2020. Elsevier Inc. All rights reserved.
J AM ACAD DERMATOL
JULY 2020
with secukinumab for psoriasis. JAAD Case Rep. 2018;4(5):
486-488.
51. Mumoli N, Vitale J, Gambaccini L, Sabatini S, Brondi B, Cei M.
Erythrodermic psoriasis. QJM. 2014;107(4):315.
52. Richetta AG, Maiani E, Carlomagno V, et al. Treatment of
erythrodermic psoriasis in HCV1 patient with adalimumab.
Dermatol Ther. 2009;22(Suppl 1):S16-S18.
53. Vidal D, Peramiquel L, Olivella R, Villar M, Petiti G, Gonz
alez A.
Erythrodermic psoriasis successfully treated with adalimumab:
a case study. J Eur Acad Dermatol Venereol. 2013;27(S4):68.
54. Saeki H, Nakagawa H, Nakajo K, et al. Efficacy and safety of
ixekizumab treatment for Japanese patients with moderate to
severe plaque psoriasis, erythrodermic psoriasis and general-
ized pustular psoriasis: results from a 52-week, open-label,
phase 3 study (UNCOVER-J). J Dermatol. 2017;44(4):355-362.
55. Lee WK, Kim GW, Cho HH, et al. Erythrodermic psoriasis treated
with golimumab: a case report. Ann Dermatol. 2015;27(4):446-449.
56. Sano S, Kubo H, Morishima H, Goto R, Zheng R, Nakagawa H.
Guselkumab, a human interleukin-23 monoclonal antibody in
Japanese patients with generalized pustular psoriasis and
erythrodermic psoriasis: efficacy and safety analyses of a 52-
week, phase 3, multicenter, open-label study. J Dermatol.
2018;45(5):529-539.
57. Viguier M, Pages C, Aubin F, et al. Efficacy and safety of
biologics in erythrodermic psoriasis: a multicentre, retrospec-
tive study. Br J Dermatol. 2012;167(2):417-423.
58. Sahel H, Otsmane F, Bouadjar B. Treatment of erythrodermic
psoriasis with biological therapies in two cases. J Eur Acad
Dermatol Venereol. 2016;30(S6):102.