Remission of Recalcitrant Psoriasis on Combined Biologic Therapy With Infliximab and Ustekinumab

Abstract

Introduction: Anti-TNF treatment is effective for inflammatory bowel disease (IBD), however it also has the potential to cause paradoxical psoriasis which can be challenging to manage. Discontinuation of anti-TNF agents may improve psoriatic lesions but may worsen IBD. Combining biologic therapies, though not yet commonly practiced, may be a useful approach to the treatment of both conditions. Case Presentation: We describe a case of paradoxical palmoplantar psoriasis in a 48-year-old woman with ulcerative colitis (UC). Her UC was well-managed on infliximab. Following trials of several other topical and systemic therapies for her psoriatic lesions, she ultimately received relief on combined ustekinumab and infliximab therapy without flare of her IBD. Discussion: While other publications report success using ustekinumab for paradoxical psoriasis following cessation of infliximab, this case report highlights successful treatment using a combination of ustekinumab and infliximab with no reported adverse effects at 3 months. Conclusion: Discontinuation of the anti-TNF agent and use of a single biologic that may treat both IBD and psoriasis is a treatment option. Additionally, combining biologic therapies, though not yet commonly practiced, may be a useful, albeit costly, approach to prevent potential flares of IBD that may accompany cessation of some biologics. Further studies may be beneficial to assess for long term adverse effects.