Temporarily induced facial eczema by IL-17 inhibitors: A case report and literature review

Ting Zhang¹Fanzhang Meng²Junchen He¹Chen Li^1*Zuotao Zhao^1*

• ¹Department of Dermatology, Tianjin Institute of Integrative Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
• ²School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, China

Biologics targeting interleukin-17 (IL-17) are widely used for moderate to severe psoriasis with great efficiency. Nonetheless, their usage has sporadically resulted in paradoxical reactions, such as eczema, sarcoidosis-like eruptions, alopecia areata, pyoderma gangrenosum and so on. Here, we report a case of temporarily facial eczema to secukinumab with a score of 5 on the Naranjo scale which suggests a probable drug side effect. A 32-year-old Chinese male with a history of chronic plaque psoriasis for 5 years. He was previously treated with topical steroids, calcipotriol, narrow-band ultraviolet B phototherapy and oral traditional Chinese medicine intermittently since 2020. In January of 2025 his psoriasis exacerbated and was not well controlled. The patient underwent an initial regimen of 300mg secukinumab once weekly for 4 weeks with significant PASI improvement and was scheduled to continue maintenance therapy on a regimen of every 4 weeks. However, in the seventh week of the secukinumab treatment course, the patient's face developed diffuse, swollen, erythematous patches that have almost coalesced into sheets. The surface is smooth, without scales, blisters, or exudation, and accompanied by mild itching. Lab tests shows elevated alanine aminotransferase (ALT) at 83.2 U/L (normal range: 9-50 U/L), slightly increased direct bilirubin at 8.48 μmol/L (normal range: 0-8.0 μmol/L). Other lab tests showed no significant abnormalities. After oral compound glycyrrhizin 、 olopatadine hydrochloride 、triprolidine hydrochloride, topical pimecrolimus for a week, his facial lesions were completely cleared. Liver function tests normalized following a 2-week course of polyenphosphatidylcholine. The patient delayed secukinumab administration by 2 weeks and continue 300 mg secukinumab administration on a regimen of every 4 weeks. No recurrence of similar rash or other adverse effects was observed during the subsequent follow-up period over 5 months. It is concluded that eczema could be induced temporarily by secukinumab, and maybe continued application.