Giovanni Palazzo*
Introduction: This case report documents the efficacy and safety of secukinumab in severe paediatric psoriasis (PP) with serious comorbidities and quality of life (QOL) implications, and it contributes data to the body of evidence supporting its use in routine clinical practice.
Main symptoms: A 14-year-old female with severe plaque psoriasis manifesting as small seborrheic plaques affecting her scalp, face, trunk, and the rest of her body (100% of body surface area). Her Psoriasis Area Severity Index score was 12, her Children Dermatology Life Quality Index score was 20, and her Visual Analogue Scale score was 7.
Main diagnoses, treatments, and outcomes: Upon considering available treatment options, it was concluded that conventional disease-modifying antirheumatic drugs (cDMARDs) were contraindicated. Also, because the condition severely affected the patient’s QOL, biologic disease-modifying antirheumatic drugs with a rapid onset of action were preferred. The patient was offered treatment with secukinumab, a humanised, recombinant monoclonal anti-IL-17A antibody. Once treatment was initiated, the patient’s condition started improving within two weeks of the first dose. Three weeks after the start of treatment, the patient’s trunk, buttocks, thighs, and legs were scarcely affected, while her face presented mild residual lesions. Four weeks after the start of treatment, only slight residual lesions remained on the patient’s face. The patient's haematologic and blood chemistry profile remained normal throughout her treatment and her examinations at each follow up visit were consistently normal.
Conclusion: This case shows an optimal clinical response and rapid cutaneous clearance with good safety when secukinumab is administered to an adolescent with severe plaque psoriasis. During this period, the patient recovered her relational capacity, which plays a decisive role in the psychic development of adolescents.