Treatment of erythrodermic psoriasis with biologics: A systematic review.

Abstract Background Biologic medications for plaque psoriasis have been used to treat erythrodermic psoriasis (EP). Since the guidelines for management of EP were published, new biologics have been approved for the treatment of plaque psoriasis. Objective To analyze the evidence of biologic medications in the treatment of EP based on response and tolerability. Methods A comprehensive search was conducted with the PubMed, Cochrane Library, EMBASE, and Scopus databases through December 31, 2018. Studies reporting one or more cases of EP, defined as >75% body surface area involvement, in patients ≥18 years old treated with biologics were included. Baseline PASI score, PASI score improvement, and adverse events were documented. Adequate response to treatment was defined as PASI≥ 50. Results Forty-three articles were included, yielding a total of 179 patients. Most patients responded at some point during treatment, with a higher level of evidence for infliximab, ustekinumab, ixekizumab, and guselkumab. Infection was the most common adverse event (n=35). Limitations Data is limited to case reports, case series, and uncontrolled studies. Conclusions Patients with EP treated with biologics demonstrated positive responses and treatment was well-tolerated with a weak recommendation and limited quality of evidence in favor of infliximab, ustekinumab, ixekizumab, and guselkumab.