Psoriatic erythroderma and the efficacy of the IL-23 inhibitor guselkumab in clinical practice

Psoriatic erythroderma is the most severe and rare form of psoriasis, with damage to at least 90 % of the body surface area. Most often, psoriatic erythroderma develops in patients with uncontrolled psoriasis and without timely treatment becomes a potentially life-threatening condition. Against the background of generalized damage to the skin, there is a high risk of developing systemic disorders, and therefore effective and safe treatment methods are needed. Traditional systemic drugs such as retinoids, cyclosporine and methotrexate are not effective and safe enough for psoriatic erythroderma, and in most cases have contraindications associated with comorbid conditions. Systemic genetically engineered biological drugs, including TNF-a inhibitors, IL-17 inhibitors, IL-12/23 inhibitors, IL-23 inhibitors show high efficacy and safety in vulgar psoriasis, which makes it possible to use them in psoriatic erythroderma. However, studies and publications regarding the appointment of systemic biological therapy in psoriatic erythroderma are isolated despite the fact that this is a severe, albeit rare form of psoriasis. Data on the use, as well as the efficacy and safety of the IL-23 inhibitor guselkumab in psoriatic erythroderma are limited. In this article we discuss the clinical manifestations of psoriatic erythroderma, the impact on the quality of life of patients and, using clinical cases as an example, the efficacy and safety of genetically engineered biological therapy with an IL-23 inhibitor (guselkumab) for psoriatic erythroderma are shown.