Successful management of ustekinumab-induced pustular psoriasis without therapy discontinuation

We present a 34-year-old female patient with methotrexate unresponsive longstanding plaque psoriasis who developed pustular psoriasis ten weeks after initiation of ustekinumab therapy. Given the lack of other side effects and the rapid initial response of the underlying plaque psoriasis, we opted against discontinuing ustekinumab therapy. Topical corticosteroids were added for the management of pustular lesions on initial presentation. Given the treatment-resistant nature of our patient's underlying plaque psoriasis, we chose dose-intense regimen (every 8 weeks). After successful remission of the pustular lesions, topical corticosteroids were discontinued. Following nearly complete clearance of the underlying plaque psoriasis, maintenance ustekinumab therapy at the recommended 12-week intervals was initiated starting week 28. No recurrence of pustular psoriasis was noted during the 18-month follow-up. Our experience shows that pustular lesions associated with ustekinumab can be successfully managed with topical corticosteroids without discontinuing ustekinumab therapy and compromising therapeutic benefit seen in the underlying condition.