Complete primary treatment failure of adalimumab in a patient with photoaggravated psoriasis

摘要

To the Editor, While psoriasis most commonly improves with sun exposure, an effect that is capitalized upon by using ultraviolet light in phototherapy for this condition, a subset of psoriasis patients experiences triggering or worsening upon sun exposure. This has been termed photosensitive or photoaggravated psoriasis and usually presents with typical plaque-type psoriasis in sun-exposed areas with worsening in summer months. The underlying mechanisms are unknown but are believed to be heterogeneous, including kobnerization after sunburning or by other coexistent photosensitive disorders, in particular polymorphous light eruption (PMLE), and by direct de novo triggering (1, 2). In patients whose psoriasis is triggered without sunburning and without a coexisting photosensitive disorder, the time interval between sun exposure and occurrence of psoriasis lesions has been suggested to be longer as compared with patients whose psoriasis appears to be UV-kobnerized . In the majority of patients with photosensitive psoriasis, psoriatic skin lesions can be triggered by relatively low doses of broadband UVA (1) or by UVB (erythematous, sometimes suberythematous doses) (3, 4). A strong influence of hereditary factors is suggested by an association with a positive family history of psoriasis, early onset, and an association with HLA-Cw*0602 (type 1 psoriasis) . Reports on treatments of photoaggravated psoriasis are mostly anecdotal, including cyclosporine, infliximab, and UVB, but include a series of successful use of photochemotherapy, both of PMLE-associated and non-PMLE-associated cases .