title: Successful use of the excimer laser for generalized psoriasis in an ustekinumab non-responder.
abstract: Effective treatments for moderate to severe psoriasis are phototherapy and biologics. These treatments are similar in that they both decrease cutaneous immune system hyperactivity yet do so via different mechanisms. Our patient, a 63 year old Asian male had a rapid response to treatment with the high dose excimer laser, having previously failed treatment with 28 weeks of ustekinumab therapy. A pre-treatment biopsy of a psoriatic plaque was found to contain relatively low levels of IFN-γ (Th1) and IL-17 (Th17) secreting T cells. Following treatment with the excimer laser, the patient had a quick improvement in PASI that was reflected by a 3-fold reduction in the number of live T cells found in the post-treatment biopsy. Although ustekinumab and the excimer laser both result in decreased levels of these cytokines, the excimer laser directly causes apoptosis of T cells and induces DNA damage in antigen presenting cells. Thus, the broader effects of phototherapy on immune cells compared to the targeted inhibition of IL-12 and IL-23 by ustekinumab likely account for the superior response observed.
authors.affiliation: Chicago Medical School, Rosalind Franklin University of Medicine and Science University of California San Francisco Psoriasis Treatment Center.
authors.forename: Mona
authors.initials: M
authors.lastname: Malakouti
authors.forename: Gabrielle Elena
authors.initials: GE
authors.lastname: Brown
authors.forename: Eric
authors.initials: E
authors.lastname: Sorenson
authors.forename: Argentina
authors.initials: A
authors.lastname: Leon
authors.forename: John
authors.initials: J
authors.lastname: Koo
authors.forename: Ethan Charles
authors.initials: EC
authors.lastname: Levin
mesh_terms: D000279:Administration, Cutaneous; D002117:Calcitriol / Q000627:therapeutic use*; D002990:Clobetasol / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003879:Dermatologic Agents / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009824:Ointments; D011565:Psoriasis / Q000628:therapy*; D017211:Treatment Failure; D000069549:Ustekinumab / Q000627:therapeutic use
chemical_list: D003879:Dermatologic Agents; D005938:Glucocorticoids; D009824:Ointments; D002990:Clobetasol; D000069549:Ustekinumab; D002117:Calcitriol