Long-term combination therapy of ustekinumab and dapsone in a patient with psoriasis and dermatitis herpetiformis Duhring
Abstract
Psoriasis vulgaris is recently associated with other comorbidities like metabolic syndrome and cardiovascular disease. Some studies have also shown connection to celiac disease, a multisystemic disorder associated with skin manifestations like dermatitis herpetiformis Duhring as well as the systemic symptoms.
Coexistence of psoriasis vulgaris and celiac disease has been supported by strong evidence. Cianci et al. have shown an increased frequency of Ig heavy-chain HS1,2-A enhancer *2 allele in dermatitis herpetiformis, plaque psoriasis and psoriatic arthritis which suggests a related genetic predisposition in the pathogenesis of these diseases.
On the other hand, association with dermatitis herpetiformis is very rare with only some anecdotal reports. Most of these patients were treated only by gluten-free diet or in combination with dapsone.
To the best of our knowledge, none of these patients had been on a biologic agent and therefore there is no clinical evidence so far on the safety of combinations of sulfones and biologics. Our patient used ustekinumab in combination with dapsone for over a year with no adverse event.
At present, his psoriasis and dermatitis herpetiformis remain under control. It is under discussion whether ustekinumab could trigger dermatitis herpetiformis.
We tend not to support this hypothesis because the activity of neutrophils should not be in?uenced by this drug. The number of patients treated with biologics is rapidly increasing and new challenging cases will arise as biologic drugs are combined with other immunomodulatory agents.