Dermatology: Practical and Conceptual Image Letter | Dermatol Pract Concept. 2024;14(3):e2024185 1 New-Onset Blepharitis in Patient Treated with Secukinumab for Severe Psoriasis Maria Francesca Baracca1,2, Filippo Viviani1,2, Alessandro Pileri1,2, Giacomo Clarizio1,2, Federico Bardazzi1 1 Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy 2 Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy Citation: Baracca MF, Viviani F, Pileri A, Clarizio G, Bardazzi F. New-Onset Blepharitis in Patient Treated With Secukinumab for Severe Psoriasis. Dermatol Pract Concept. 2024;14(3):e2024185. DOI: https://doi.org/10.5826/dpc.1403a185 Accepted: February 14, 2024; Published: July 2024 Copyright: ©2024 Baracca et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: None. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Maria Francesca Baracca, via Massarenti 9, 40138 Bologna, Italy. Telephone/fax: +390512144843. Email: maria.baracca@studio.unibo.it Case Presentation A 63-year-old woman with a 4-year history of severe pso- riasis presented for recurrence despite initial clinical im- provement with brodalumab, started 2 years previously. She was switched to another interleukin-17 inhibitor (anti-IL-17), secukinumab, and rapid clearance of the erythematous-desquamative plaques was observed after 4 months. In the meantime, however, the patient developed significant eyelid impairment. On examination, the eyelids were mildly edematous, slightly oozing with marked ery- thema and scaling. The patient denied using any eye drops or cosmetics, so allergic contact dermatitis was ruled out. She had no history of atopic dermatitis. Treatment with topical corticosteroids slightly improved eyelid lesions in two weeks. An eczematous reaction to an anti-IL-17 drug was suspected and the therapy was changed to an IL-23 inhibitor (risankizumab), observing a fast remission of the skin lesions. Figure 1. Erythema and slight edema of the eyelids with flaking scales, which developed 4 months after the initiation of secuki- numab for treating psoriasis. 2 Image Letter | Dermatol Pract Concept. 2024;14(3):e2024185 References 1. Teraki Y, Takahashi A, Inoue Y, Takamura S. Eyelid Dermatitis as a Side Effect of Interleukin-17A Inhibitors in Psoriasis. Acta Derm Venereol. 2018;98(4):456-457. DOI: 10.2340/00015555 -2871. PMID: 29327064. 2. Alsenaid A, Piguet V, Lansang P, Miller-Monthrope Y, Yeung J, Joseph M. Brodalumab-Induced Eczematous Reactions in Psoriasis Patients: Management With Switching to Risanki- zumab. J Cutan Med Surg. 2023;27(3):236-240. DOI: 10.1177 /12034754231167140. PMID: 37014149.References 3. Teraki Y, Takahashi A, Inoue Y, Takamura S. Eyelid Dermatitis as a Side Effect of Interleukin-17A Inhibitors in Psoriasis. Acta Derm Venereol. 2018;98(4):456-457. DOI: 10.2340/00015555 -2871. PMID: 29327064. 4. Alsenaid A, Piguet V, Lansang P, Miller-Monthrope Y, Yeung J, Joseph M. Brodalumab-Induced Eczematous Reactions in Psoriasis Patients: Management With Switching to Risanki- zumab. J Cutan Med Surg. 2023;27(3):236-240. DOI: 10.1177 /12034754231167140. PMID: 37014149.Figure 1. Erythema and slight edema of the eyelids with flaking scales, which devel- oped 4 months after the initiation of secukinumab for treating psoriasis. Teaching Point In the literature is reported that eczema could be an adverse event (AE) of IL-17 inhibitors. Regarding blepharitis, other cases reported argue that it could be a class AE of IL17A inhibitors: these cytokines are essential for antimicrobial peptide production on the skin surface and their targeting can result in an overgrowth of microorganisms such as Malassezia, which might contribute to the development of eyelid dermatitis [1]. In case of severe eczematous reaction to anti-IL-17, some authors suggest discontinuing therapy and switching to a different drug class such as IL-23 inhibitors [2]. This is a valuable option for eyelid dermatitis that does not clear with topical therapy or often recurs after treatment is stopped.