Paradoxical Pustular Flare-up of Psoriasis in a Patient of Down Syndrome with Psoriasis after Starting Ixekizumab

Abstract

Paradoxical psoriasis, by definition, includes either (i) new-onset psoriasis in patients treated for a different disease or (ii) worsening and phenotypical change of preexisting psoriasis. Originally, the term was used in tumor necrosis factor-alpha using psoriasis patients, in whom new psoriasiform lesions started to appear after prolonged use. However, similar descriptions began to gain attention as the use of other biologics increased. We describe a patient with Down syndrome and severe psoriasis who developed pustular aggravation of the lesions after two dosages of ixekizumab.