Rebound of psoriasis during treatment with efalizumab

Recently, the biologics have emerged as a new class of drugs for systemic therapy of psoriasis with efalizumab (Raptiva) being one of the most recently FDA-approved agents. We report a case of a 34-year-old Caucasian male who experienced psoriasis rebound during a 7-week lapse in treatment with subcutaneous efalizumab 0.8 mg/kg/week, which he had been using for 4 weeks up to that point. The patient then restarted efalizumab, but his psoriasis continued to worsen causing him to be admitted for Goeckerman day care. He rebounded again 4 weeks following his ultimate discontinuation of efaluzimab despite intensive therapy with the Goeckerman regimen. This case is reported to highlight the recent findings that psoriasis rebound, defined as psoriasis area and severity index (PASI) of 125% or greater or morphology change, has been associated with both the use and the discontinuation of efalizumab.