Title : Unexplained blepharitis following ixekizumab therapy
Abstract:
Blepharitis is a chronic inflammatory condition that affects the eyelids, specifically at the margins where the eyelashes grow. It is characterized by redness, irritation, and swelling of the eyelid skin, occasionally causing crusting around the eyelashes. While this condition is typically self-limiting and treated with supportive therapy, its recurring nature can make management challenging causing a decreased quality of life for patients. A 33-year-old male with a history of plaque psoriasis affecting his fingernails, toenails, groin, buttocks, and scalp presented to our clinic for a follow-up after a 5-month trial of Taltz (ixekizumab) treatment. He expressed concerns over severe redness, swelling, and crusting of his upper and lower eyelid over the past 2 months. The patient had never experienced these concerns before, prompting him to see his ophthalmologist, who directed the patient to use a warm compress, artificial tears, and prescribed him neomycin-polymyxin B-dexamethasone. The symptoms failed to resolve after 6 weeks, at which point the patient was diagnosed with blepharitis. Only after self-discontinuation of his Taltz medication did the patient have symptom resolution. With a long history of failed biologics treatments for his psoriasis, the patient was switched to Tremfya (guselkumab) in order to prevent possible exacerbation and recurrence of the patient’s blepharitis. While there is an inherent risk of several adverse effects resulting from the usage of biologics, the development of blepharitis in our patient suggests an underlying immunological etiology that lead to this clinical presentation. This case suggests that more research needs to be done to further understand how blocking immunological pathways may affect other systems of the body.
