INTRODUCTION
Plaque psoriasis continues to be a great disease burden in the United States. Incidence and prevalence rates of plaque psoriasis are estimated to be 63.8 per 100,000 person-years overall and 3.0% in adults aged 20 years or older, respectively.1,2 Advances in both systemic and topical therapeutics have ushered in an era of safe non-steroidal options for many patients. Furthermore, as the treatment armamentarium becomes larger, combination therapies involving a systemic medication combined with one or more topical therapeutics will become mainstay.3 Here we report the first case of generalized plaque psoriasis treated with once daily oral deucravacitinib combined with tapinarof cream 1%.
CASE
A 37-year-old Indian male presents with 3-year history of plaque psoriasis. Deep red to violaceous nummular well circumscribed micaceous plaques with scale covered over 50% of his body surface area (>50% BSA) including the scalp, trunk, extremities and intertriginous areas including the groin, and axillary vaults (Figure 1). He denied any joint pain and personal or family history of cardiovascular disease. He was also treatment naïve having never tried any topical or systemic therapeutics aside from over-the-counter emollients.
Given the patient's frequent travel between India and the United States, his logistical need to carry pills rather than injections, and his desire for a systemic medication with a short half-life so he is able to obtain live vaccines on shorter notice than biologics, we initiated oral deucravacitinib 6 mg once daily. We also initiated tapinarof cream 1% which was applied to the affected areas once daily for synergy. At his 4-week follow-up visit, a significant therapeutic effect was noted with over 75% clearance (Figure 1). Post-inflammatory hyperpigmentation was noted at all sites. Of note, the patient endorsed a transient mild muscle ache in his legs two weeks into treatment that self-resolved prior to his week 4 follow-up visit. Laboratory evaluation of serum creatinine phosphokinase (CPK) at week 4 was within normal limits.
Given the patient's frequent travel between India and the United States, his logistical need to carry pills rather than injections, and his desire for a systemic medication with a short half-life so he is able to obtain live vaccines on shorter notice than biologics, we initiated oral deucravacitinib 6 mg once daily. We also initiated tapinarof cream 1% which was applied to the affected areas once daily for synergy. At his 4-week follow-up visit, a significant therapeutic effect was noted with over 75% clearance (Figure 1). Post-inflammatory hyperpigmentation was noted at all sites. Of note, the patient endorsed a transient mild muscle ache in his legs two weeks into treatment that self-resolved prior to his week 4 follow-up visit. Laboratory evaluation of serum creatinine phosphokinase (CPK) at week 4 was within normal limits.
