key: cord-335104-8b2tpbsh
authors: Carugno, Andrea; Gambini, Daniele Mario; Raponi, Francesca; Vezzoli, Pamela; Robustelli Test, Elisa; Arosio, Marco Enrico Giovanni; Callegaro, Annapaola; Sena, Paolo
title: Coronavirus disease 2019 (COVID‐19) rash in a psoriatic patient treated with Secukinumab: Is there a role for Interleukin 17?
date: 2020-07-27
journal: Dermatol Ther
DOI: 10.1111/dth.14011
sha: 
doc_id: 335104
cord_uid: 8b2tpbsh

nan

Various cutaneous manifestations have been observed in COVID-19 patients 1 and there has been worldwide concern among patients undergoing biologic therapies. [2] [3] [4] We report our experience with a COVID-19 psoriatic patient treated with anti-interleukin-(IL)-17 who developed a late onset rash.

A 69-year-old obese, hypertense, diabetic man was previously followed for psoriasis and psoriatic arthritis; he was treated with Secukinumab 300 mg every 4 weeks for 2 years. About 25 days after the last dose of Secukinumab he had close contact with his father, who died of COVID-19 a few days later. In the following days the patient developed mild fever, asthenia, and ageusia, bringing high suspicion of SARS-CoV-2 infection. After consultation, as precaution, we advised him not to administer the next injection of Secukinumab. All symptoms, except ageusia, were resolved in 5 days. About 5 weeks later, he referred to us due to the rapid onset of a mild pruritic erythematooedematous morbilliform rash, rapidly spreading from arms to trunk and lower limbs; he also showed an initial flare-up of his psoriasis The patient developed a mild form of COVID-19, even though his age and comorbidities are most typically associated with poorer prognosis. 6 The rash occurred about 40 days after the systemic symptoms and approximately 8 weeks after the last Secukinumab dose. The rash appeared together with the recurrence of psoriasis. At the onset of the rash, the patient still had a positive swab, but the RT-PCR search for viruses in the skin was negative.

These observations seem consistent with the hypothesis of cytokine storm and Th17 involvement in the pathogenesis of COVID-19 and COVID-19-related cutaneous manifestations. 3, 4, 7 In our case, the COVID-19 clinical course was mild and therefore we can assume secukinumab does not increase risks for the patient and could support the hypothesis of the possible therapeutic use of IL-17 inhibitors in COVID-19. [7] [8] [9] The mechanisms of COVID-19 cutaneous manifestation are still not well known. 1 The appearance of the manifestations 8 weeks after the last dose of the drug and the negativity of skin research of the virus with RT-PCR seem more consistent with the hypothesis of inflammatory pathogenesis than with the presence of peripheral viral particles.

Further observations are needed to confirm these hypotheses.

The patient in this manuscript has given written informed consent to publication of his case details. We wish to express our gratitude to Dr. Fabio Maria Carugno and Dr. Matteo Alberto Mariani for their precious help and advice.

Novel coronavirus disease (COVID-19) and biologic therapy in psoriasis: infection risk and patient counseling in uncertain times

COVID-19 and acute respiratory distress syndrome: focusing on the risk of concomitant biological treatment

Unraveling the mystery of Covid-19 cytokine storm: from skin to organ systems

Cutaneous manifestations of COVID-19: report of three cases and a review of literature

Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR

Covid-19: risk factors for severe disease and death

COVID-19: a case for inhibiting IL-17?

Reducing mortality from 2019-nCoV: host-directed therapies should be an option

Should patients stop their biologic treatment during the COVID-19 pandemic

The authors have no conflict of interest to declare. 
