Delayed generalized inflammatory psoriasis flare during efalizumab treatment

Abstract

Conflicts of interest: none declared. Sir, Efalizumab has shown a good efficacy and safety profile in multiple studies,1 although serious adverse events may occur during the treatment of psoriasis. These events include clinical worsening or the development of new forms of psoriasis during or following therapy.2 The most severe of these events is the so‐called generalized inflammatory flare that has been defined as the development of a flare of inflammatory, widespread psoriasis lesions characteristically appearing during the first 4–6 weeks of treatment. This entity typically affects patients who are not responding to efalizumab, and in some cases can be solved by adding a short course of classic psoriasis systemic therapy to the biologic agent.3 Worsening or de novo psoriatic arthritis during or following efalizumab therapy has also been reported.4, 5 Bang and Gniadecki6 suggested that this phenomenon could be explained by the mechanism of action of the drug, which impairs T‐lymphocyte trafficking to sites of cutaneous inflammation. Thus T cells would be redistributed and increased in other compartments such as the joints, provoking the articular response. A previous history of arthropathy and poor clinical response seem to increase the possibility of developing articular symptoms.7