Resolution of Guttate Psoriasis Plaques After One-time Administration of Guselkumab

August 2019 | Volume 18 | Issue 8 | Case Reports | 822 | Copyright © August 2019

Shalanda L. Hall BSN DPM, Wasim Haidari BS BA, Steven R. Feldman MD PhD

Wake Forest Baptist Medical Center, Winston-Salem, NC

intracellular and downstream signaling of IL-23 by binding to the p19 cytokine subunit of IL-23, thereby preventing the terminal differentiation and survival of Th17 cells.3,4 The end result of IL-23/Th17 pathway inhibition is prevention of the small, scaly plaques, and papules characteristic of psoriasis.

Guttate psoriasis can go into remission, allowing short term courses of phototherapy or methotrexate to be effective treatments. Guselkumab is more effective than methotrexate (guselkumab is more effective head-to-head compared to adalimumab, which is more effective than methotrexate)4-6 and the effects of guselkumab are long lived (with almost 40% of patients maintaining 90% improvement in Psoriasis Area and Severity Index for 6 months after just 4 doses of the medication). 5 Based on that, we expected that the patient with the flare of psoriasis plaques in a guttate pattern would respond well to the treatment.

Long-term studies of guselkumab will be important for determining its efficacy and safety. We suspect one-time dosing with a potent, long acting medication like guselkumab may be a very effective, safe, and convenient way to manage acute and extensive exacerbations of psoriasis.


  1. Wu JJ, Gudjonsson JE. “Psoriasis and Systemic Disease.” Dermatologic Signs of Systemic Disease, 5th ed., Elsevier, Inc., 2017, pp. 45–50.
  2. Owen CM, Chalmers R, O’Sullivan T, Griffiths CEM. Antistreptococcal interventions for guttate and chronic plaque psoriasis. Cochrane Database Syst Rev. 2019;6:3.
  3. Wechter T, Cline A, Feldman SR. Targeting p19 as a treatment option for psoriasis: an evidence-based review of guselkumab. Ther Clin Risk Manag. 2018;14:1489-1497.
  4. Blauvelt A, et al. Efficacy and safety of guselkumab, an anti-interleukin-23 monoclonal antibody, compared with adalimumab for the continuous treatment of patients with moderate to severe psoriasis: results from the phase III, double-blinded, placebo- and active comparator–controlled VOYAGE 1 trial. J Am Acad Dermatol. 2017;76(3):405-417.
  5. Reich K, Armstrong AW, Foley P et al. Efficacy and safety of guselkumab compared with adalimumab for the treatment of moderate-to-severe psoriasis: results from the phase 3, double-blind, placebo- and active comparatorcontrolled VOYAGE 2 trial. J Am Acad Dermatol. 2017;76:418–431.
  6. Saurat, J.-H., et al. Efficacy and safety results from the randomized controlled comparative study of adalimumab vs. methotrexate vs. placebo in patients with psoriasis (CHAMPION).” Br J Dermatol. 2007;158:558–566.


Wasim Haidari BS BA