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Breakthrough Psoriasis in Patients Receiving Biologicals.

Thomas Damsin1, Gilles Absil1, Florence Libon1

  • 1Department of Dermatology and Venerology, CHU of Sart Tilman, University of Liège B-4000, Liège, Belgium.

Psoriasis (Auckland, N.Z.)
|January 9, 2025
PubMed
Summary
This summary is machine-generated.

Breakthrough psoriasis is rare in patients on biological therapy, occurring in about 1.13% of cases. These rare events are typically triggered by the Köbner phenomenon or severe psychological stress, not treatment timing.

Keywords:
IL17IL23Köbner phenomenonTNF-alphabiologicalspsoriasisstress

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Area of Science:

  • Dermatology
  • Immunology
  • Pharmacology

Background:

  • Biological therapies effectively manage moderate-to-severe psoriasis, offering long-term safety.
  • Despite stable disease or remission, some patients on biologicals experience sudden psoriasis flares.

Purpose of the Study:

  • To prospectively investigate the clinical characteristics of breakthrough psoriasis in stabilized patients on biological therapy.
  • To describe triggers, rescue therapies, and outcomes of sudden psoriasis flares during biological treatment.

Main Methods:

  • A 5-year prospective follow-up study included 985 psoriasis patients achieving PASI 90-100 on biologicals.
  • Clinical features of breakthrough psoriasis, rescue treatments, and outcomes were documented.

Main Results:

  • Breakthrough psoriasis occurred in 1.13% (10/882) of patients over 5 years.
  • Triggers identified were Köbner phenomenon (2 cases) and severe psychological stress (8 cases).
  • Rescue therapies included potent topical corticosteroids or additional biological injections; two patients improved after stress resolution.

Conclusions:

  • Breakthrough psoriasis is an exceptional event in biologically treated, stable psoriasis patients.
  • Events are linked to Köbner phenomenon or severe psychological stress, potentially via immunomodulation.
  • No specific biological agent or dosing schedule was implicated.