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Refractory psoriasis following long-term corticosteroid withdrawal and in- adequate response to cyclosporine: a case report
Article Type: Case Study
Author: V. Mahender,
Volume: Volume 1
Issue: Issue 1
Year: 2026
Keywords
Psoriasis
Corticosteroid withdrawal
Cyclosporine
Ixekizumab
IL-17A inhibitor
Biologic therapy
Abstract
Psoriasis is a chronic immune-mediated skin disorder characterized by erythematous, scaly plaques. We report
a case of a 53-year-old male with a 12-year history of psoriasis and diabetes mellitus who presented with severe
exacerbation following long-term corticosteroid use and subsequent cyclosporine therapy. The patient developed
high-grade fever, widespread erythematous rashes with peeling, and severe itching, along with abnormal
hematological findings. Initial management with cyclosporine and topical corticosteroids provided limited
benefit, and abrupt withdrawal of prednisolone triggered a rebound flare due to a surge in pro-inflammatory
cytokines. Cyclosporine therapy further led to paradoxical worsening of psoriasis, likely due to suboptimal
response. The patient was subsequently initiated on ixekizumab, an IL-17A inhibitor, which demonstrated
significant clinical improvement and near-resolution of psoriatic lesions. This case emphasizes the challenges in
managing severe psoriasis in patients with prolonged corticosteroid exposure and highlights the role of biologic
therapy as an effective treatment option in refractory cases.