Abstract
A 57-year-old Japanese man had been diagnosed with psoriasis vulgaris based on the presence of widespread erythema on his whole body at 5 years prior to his current presentation. He had persistent erythema on the upper back and lumbar areas that was resistant to the topical treatment of the strongest class of corticosteroid (clobetasol propionate 0.05%) and narrow-band ultraviolet B (UVB) therapy for 3 years. Oral apremilast was introduced but discontinued soon because of severe headaches. Then, because he refused to undergo expensive treatments, reactive administration of oral deucravacitinib (6 mg/day) was initiation, which resulted in the disappearance of skin eruptions 3 months later. Thereafter, topical betamethasone butyrate propionate 0.05% ointment and weekly or biweekly narrow-band UVB exposure prevented the development of exacerbations for 9 months. However, since severe erythema appeared on the elbow and knee, deucravacitinib was again started; 4 weeks later, the erythema disappeared. Finally, maintenance therapy with topical betamethasone butyrate propionate and narrow-band UVB well controlled his condition for 1 year. Together, the reactive administration of deucravacitinib was useful for patients with psoriasis who wish to reduce their treatment cost.
