Successful management of chronic plaque psoriasis with secukinumab in a patient with hematological abnormalities: A 25-year disease history

R Indhra Priyadharshini

Consultant-Dermatology, Kauvery Hospital, Vadapalani, Chennai

Abstract

Background: Chronic plaque psoriasis is an immune-mediated inflammatory skin disorder often associated with systemic comorbidities. Advances in biologic therapy, particularly interleukin-17 inhibitors, have transformed management outcomes.

Case Presentation: A 57-year-old male with a 25-year history of chronic plaque psoriasis presented with extensive erythematous, scaly plaques. On admission, he had anaemia (hemoglobin 10 g/dL) and thrombocytosis (platelet count 881 × 10³/µL). Following correction of anaemia with iron infusion, the patient was started on Secukinumab 300 mg subcutaneously, given weekly for five loading doses followed by monthly maintenance. After 5 doses, the patient achieved PASI 90 response with near-complete clearance of lesions. Hematological abnormalities also normalized (hemoglobin 12.9 g/dL, platelets 390 × 10³/µL). No adverse effects were observed.

Conclusion: Secukinumab is highly effective in long-standing, treatment-resistant psoriasis, offering not only cutaneous clearance but also systemic improvement in hematological abnormalities.

Keywords: Psoriasis, Chronic plaque psoriasis, Secukinumab, IL-17 inhibitor, Biologics, Thrombocytosis, Anaemia.

Introduction

Psoriasis is a chronic, immune-mediated inflammatory disease with a global prevalence of 2–3%, characterized by well-demarcated erythematous plaques with silvery scales. Chronic plaque psoriasis accounts for 80–90% of cases and has profound effects on quality of life. Beyond skin involvement, psoriasis is associated with systemic comorbidities including arthritis, cardiovascular disease, and hematological changes such as anaemia and thrombocytosis¹.

Conventional systemic agents (methotrexate, cyclosporine) and phototherapy provide partial benefit but are limited by toxicity and relapses. Biologic therapies targeting specific immune pathways, particularly the IL-23/IL-17 axis, have revolutionized management². Secukinumab, a fully human monoclonal antibody that selectively binds interleukin-17A, has shown robust efficacy in moderate-to-severe psoriasis³. We present a case of a 57-year-old male with 25 years of psoriasis and associated hematological abnormalities, who achieved remarkable improvement with Secukinumab.

Case Presentation

A 57-year-old male with a 25-year history of chronic plaque psoriasis presented with widespread erythematous, scaly plaques over the scalp, trunk, and extremities, associated with severe pruritus and psychological distress.

Clinical and Laboratory Findings

  • PASI: 24 (severe disease)
  • DLQI: 21 (severe impairment)

Baseline Investigations:

  • Hemoglobin: 10 g/dL (low)
  • Platelets: 881 × 10³/µL (thrombocytosis)
  • Liver and renal functions: normal
  • Viral markers (HBV, HCV, HIV): negative
  • Chest X-ray: normal

An iron infusion was given for anaemia before initiation of biologic therapy.

Treatment and Response

The patient was started on Injection Secukinumab 300 mg subcutaneously at weeks 0, 1, 2, 3, and 4 (loading), followed by monthly maintenance.

  • Week 2: PASI reduced to 12
  • Week 4: PASI 75 achieved
  • Week 6: PASI 90 (near-complete clearance)
  • DLQI improved from 21 → 3
  • Hemoglobin: 10 → 12.9 g/dL
  • Platelets: 881 × 10³/µL → 390 × 10³/µL

No adverse effects were reported.

Figures

 Fig:(A & B) and (C & D)

Fig (A & B): Baseline clinical photographs showing extensive erythematous, scaly plaques over back, chest, and upper limbs.

Fig (C & D): Post-treatment photographs at 6 weeks after 5 loading doses of Secukinumab, demonstrating near-complete clearance with residual post-inflammatory hyperpigmentation.

Discussion

Psoriasis is driven by dysregulated immune pathways, especially the IL-23/IL-17 axis, which plays a pivotal role in keratinocyte proliferation and chronic inflammation. Conventional systemic agents such as methotrexate and cyclosporine, though effective, are associated with cumulative toxicity and limited long-term efficacy.

This case highlights the dual benefit of Secukinumab in treating both cutaneous manifestations and systemic inflammation in chronic plaque psoriasis.Anaemia and thrombocytosis are known to occur in chronic inflammatory states, driven by cytokines such as IL-6 and TNF-α¹. By targeting IL-17A, Secukinumab reduces systemic inflammation, which may have contributed to normalization of hematological abnormalities in our patient, alongside iron supplementation.

Clinical trials such as ERASURE and FIXTURE have demonstrated the superiority of Secukinumab over placebo³, with high proportions of patients achieving PASI 75–90 responses within 12–16 weeks. Furthermore, the CLEAR trial showed Secukinumab to be superior to Ustekinumab in sustained skin clearance⁴.

In this patient with 25 years of recalcitrant disease, Secukinumab provided dramatic improvement with significant reduction in PASI and DLQI scores, validating its role as a first-line biologic in severe, chronic, and refractory psoriasis. Importantly, the therapy was well-tolerated without any major side effects.This case emphasizes that biologic therapy should be considered early in long-standing, treatment-resistant psoriasis, especially when systemic abnormalities coexist².

Conclusion

Secukinumab is highly effective and safe in chronic plaque psoriasis, even in patients with decades-long disease and systemic complications. Beyond skin clearance, it may improve hematological parameters by controlling systemic inflammation. Early biologic intervention should be considered to prevent long-term morbidity and improve quality of life.

References

  • Nestle FO, Kaplan DH, Barker J. Psoriasis. N Engl J Med. 2009; 361:496–509.
  • Armstrong AW, Read C. Pathophysiology, clinical presentation, and treatment of psoriasis: A review. 2020;323(19):1945–1960.
  • Langley RG, et al. Secukinumab in plaque psoriasis — results of two phase 3 trials. N Engl J Med. 2014; 371:326–338.
  • Blauvelt A, et al. Secukinumab is superior to ustekinumab in clearing skin of subjects with moderate-to-severe plaque psoriasis: CLEAR study. J Am Acad Dermatol.2017;76(1):60–69.

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