Combination therapy of recalcitrant severe psoriasis with psoriatic arthritis, diabetes nephropathy, and liver cirrhosis

Abstract

Objective: Treatment of recalcitrant moderate-to-severe psoriasis can be challenging. Combination therapy of biologics and immunosuppressive agents can be a new strat-egy for treating therapy- resistant cases with comorbidities, where many systemic medications are contraindicated.Case presentation: We report a case of a 62-year-old diabetic man with a 30-year history of severe plaque psoriasis and psoriatic arthritis with cirrhosis and diabetic nephropathy that was treated successfully in combination with apremilast and etaner-cept after multiple previous unsuccessful treatment attempts.Conclusion: There are no data supporting the combination of apremilast and etaner-cept in the management of recalcitrant cases of moderate-to-severe psoriasis and multiple comorbidities including psoriatic arthritis, diabetic nephropathy, and cirrho-sis. In patients who do not respond to multiple approaches for the treatment of pso-riasis, combination therapy with biologic agents and new systemic medications may lead to dramatic disease control.