Details

Autor(en) / Beteiligte

• Seidel, Paloma A.
• Braun, Stephan A.
• Magnolo, Nina

Titel

Psoriasiform dermatitis in a person of colour with chronic hepatitis B

Ist Teil von

• JEADV clinical practice, 2024-07, Vol.3 (3), p.882-886

Ort / Verlag

Wiley

Erscheinungsjahr

2024

Quelle

Wiley Online Library

Beschreibungen/Notizen

• A 43‐year‐old patient from Liberia presented with itching scaly plaques, impaired quality of life persisting for 9 months and intermittent joint pain in the knees. Personal and family history was unremarkable. Coexisting diagnoses included type 1 diabetes mellitus and liver cirrhosis due to chronic hepatitis B and D. The patient reported ongoing use of Tenofovir, Propranolol, Glargine and Aspart. Clinical examination showed disseminated brownish, partly confluent hyperkeratotic plaques distributed throughout the integument in a Fitzpatrick skin type V. A skin biopsy revealed histologically a psoriasiform dermatitis. Laboratory findings included lymphocytopenia and elevated liver values. Hepatitis B serology confirmed chronic hepatitis B. Considering the clinical and histopathological findings Psoriasis vulgaris was diagnosed and psoriatic arthritis was ruled out by a rheumatologist. After consulting with the hepatologist, systemic therapy with Apremilast was initiated. Despite an initial positive response, gastrointestinal side effects led to a switch to therapy with Tildrakizumab, with regular monitoring of transaminases and HBV DNA. Despite an initial positive treatment response, a secondary loss of efficacy occurred prompting a switch to Risankizumab. Psoriasis is a chronic inflammatory systemic disease significantly impacting quality of life, necessitating optimal long‐term management. In this case, therapy with Apremilast and biologic therapy targeting IL‐23 blockade, even with concurrent hepatitis B, was well tolerated and effective. However, the evidence on the safety of modern psoriasis therapies in known chronic infections remains limited. Noteworthy in this case report is the patient's dark skin type. Diagnosing inflammatory dermatoses in People of Colour is challenging due to less visible erythema and other clinical nuances, exacerbating the already poorer healthcare for People of Colour. This case aims to raise awareness about the need for increased representation of People of Colour in education, presentations and clinical trials to ensure better care for this patient population. A 43‐year‐old Liberian patient presented with itching scaly plaques and known hepatitis B and D. Histologically and clinically a Psoriasis vulgaris was diagnosed. The initial therapy with Apremilast was switched to Tildrakizumab due to side effects, and later to Risankizumab due to secondary loss of efficacy. Managing psoriasis in dark skin is challenging due to subtle clinical signs. This case highlights the need for better representation of People of Color in medical education and research for improved care.