Case Study: Treatment With Adalimumab Biosimilar Resolved Pediatric Scalp, Nail Psoriasis

A case study outlined a pediatric case of scalp and nail psoriasis, which was successfully treated with an adalimumab biosimilar and monitored with in vivo reflectance confocal microscopy (RCM).

After 24 weeks of adalimumab therapy, PASI 100—a complete resolution based on Psoriasis Area Severity Index (PASI)—was achieved. To the authors’ knowledge, this is the first case of a pediatric patient with nail and scalp psoriasis successfully treated with adalimumab biosimilar and evaluated with RCM.

The physicians who treated the patient and published the article pointed out that the scalp is the area of the body most frequently affected by psoriasis, and nail psoriasis is also common. Psoriasis of the nail and scalp they said “are difficult to treat and cause severe quality of life impairment.”

Adalimumab, an antibody targeting tumor necrosis factor (TNF) alpha, is approved for treatment of psoriasis in the United States and European Union. After previous therapies, including topical treatment and cyclosporine, had failed, the patient initiated an adalimumab biosimilar.

According to the authors, the 16-year-old male patient had moderate-to-severe psoriasis on the scalp, palms, soles of the feet, and “severe nail involvement.” Before starting adalimumab therapy, the patient had a PASI of 8.6, Psoriasis Scalp Severity Index (PSSI) of 30, and Nail Psoriasis Severity Index (NAPSI) of 160, with 80% of the scalp area and 20% of palms and
soles of the feet affected.

Reflectance Confocal Microscopy for Evaluation of Psoriasis Severity

According to the authors, in vivo RCM “performs a noninvasive, real-time evaluation of the skin, from the epidermis to the papillary dermis, being therefore a useful tool to analyze psoriasis treatment response.”

They noted that RCM has been used to evaluate a variety of dermatologic conditions, including skin cancers and inflammatory skin conditions. They cited previous research suggesting the use of RCM for evaluating psoriasis severity could detect “not only clinical but also subclinical
changes,” and a previous study that evaluated improvement of psoriasis using RCM, but did not include scalp and nail lesions.

Improvement Following Adalimumab Biosimilar Treatment

After 12 weeks of treatment, “significant improvement was observed” based on both clinical examination and RCM. The authors reported that PASI 75 (75% reduction of baseline PASI) and PSSI 90 (90% reduction of baseline PSSI) were reached by 12 weeks. Body surface area had decreased from 9.5% to 1%. The patient's NAPSI score had decreased from
160 to 14. After 24 weeks of adalimumab treatment, PASI 100 was achieved, and the patient's nail psoriasis was “completely resolved.”

At 12 weeks, evaluation with RCM “confirmed the improvement of scalp and nails conditions but failed to show a normal conformation.” However, at 24 weeks, “RCM confirmed resolution of the lesions.” Psoriasis resolution was also confirmed by dermoscopy.

The authors said their findings support the use of RCM as “a promising instrument for monitoring nail and scalp psoriasis,” adding that RCM could provide early diagnosis prior to clinical signs, “making a timely therapeutic intervention possible.”

Reference
Megna M, Villani A, Potestio L, Camela E, Fabbrocini G, Ocampo-Garza SS. Adalimumab biosimilar in a pediatric patient: clinical and in vivo reflectance confocal microscopy evaluation. Dermatol Ther. 2022;35(9):e15679. doi:10.1111/dth.15679