Sir,

Psoriasis is associated with various comorbidities, including kidney disease. We herein report a case of severe psoriasis in a patient undergoing hemodialysis, which was successfully treated with a single injection of ixekizumab.

A 60-year-old male was referred to our department complaining of generalized scaly erythema on the face, trunk, and extremities. He had been diagnosed with psoriasis 10 years earlier, which had worsened several months before presentation. He had chronic kidney disease (nephrosclerosis), and had been receiving hemodialysis for 15 years. Physical examination showed a number of erythematous plaques with silvery scales on the face (Fig. 1a), and diffuse scaly erythema on the trunk (Fig. 1b). Nail psoriasis was also observed. Histopathological examination revealed regular acanthosis with focal parakeratosis, and perivascular mononuclear cell infiltration in the papillary dermis (Fig. 2). The patient’s Psoriasis Area and Severity Index (PASI) score was 35.8. Treatment with subcutaneous ixekizumab was started at a loading dose of 160 mg, resulting in marked improvement 2 weeks later (Fig. 3). Because of pain during injection, treatment was switched to topical therapy. Thereafter, he stopped coming to our department.

	Figure 1: Diffuse scaly erythema on the face (a) and back (b).
	Figure 2: Histopathological features showing regular acanthosis with parakeratosis.
	Figure 3: Marked improvement after single injection of ixekizumab.

Psoriasis is a systemic inflammatory disease with various comorbidities, and has a significantly increased risk of chronic kidney disease [1,2]. Th17 cell, which produce IL-17, are implicated in the pathogenesis of renal diseases [3], and high levels of IL-17 in psoriasis may induce renal inflammation, potentially leading to glomerulonephritis and other renal injury [4]. Moreover, new-onset psoriasis in patients on hemodialysis has occasionally been reported. The patient in the present case developed psoriasis after hemodialysis was introduced, and the disease gradually worsened despite topical corticosteroid therapy. Patients on hemodialysis have been reported to exhibit a Th1-biased cytokine profile, which may play a role in the induction of psoriasis.

To date, there have been several reports of severe psoriasis successfully treated with biologics in patients undergoing hemodialysis. Among the biologics used, secukinumab was the most frequently reported, and demonstrated a favorable safety profile. In contrast, reports of ixekizumab use in this setting remain limited [5,6].

Ixekizumab is a high-molecular-weight protein that does not cross the dialysis membrane. Consequently, it is not cleared by hemodialysis. Since ixekizumab is not eliminated via the kidneys, it poses a low risk of nephrotoxicity. Biologics with shorter half-lives are generally preferred for hemodialysis patients to minimize drug accumulation. Ixekizumab’s half-life is approximately 14–18 days [7], which is shorter than secukinumab’s half-life. This suggests a pharmacokinetic advantage for ixekizumab in patients on hemodialysis. In this case, a single dose of ixekizumab elicited a rapid clinical response. However, further studies are needed to confirm the long-term safety and efficacy of ixekizumab in patients undergoing dialysis.

REFERENCES

1.  Liu KL, Tsai WC, Tu HP, Lee CH. Statin use and the risk of chronic kidney disease in patients with psoriasis:a nationwide cohort study in Taiwan. PLoS One. 2020;15:e0237816.

2.  Bu J, Ding R, Zhou L, Chen X, Shen E. Epidemiology of psoriasis and comorbid diseases:a narrative review. Front Immunol. 2022;13:880201.

3.  Zhang T, Huo H, Zhang Y, Tao J, Yang J, Rong X, et al. Th17 cells:a new target in kidney disease research. Int Rev Immunol. 2024;43:263-79.

4.  Lee E, Han JH, Bang CH, Yoo SA, Han KD, Kim HN, et al. Risk of end-stage renal disease in psoriatic patients:real-world data from a nationwide population-based cohort study. Sci Rep. 2019;9:16581.

5.  Zhu X, Pan X, Dong Z. Plaque psoriasis with renal dysfunction successfully treated with ixekizumab. Hemodial Int 2025;29:126-129.

6.  Koike Y, Fujiki Y, Higuchi M, Fukuchi R, Kuwatsuka S, Murota H. An interleukin-17 inhibitor successfully treated a complicated psoriasis and psoriatic arthritis patient with hepatitis B virus infection and end-stage kidney disease on hemodialysis. JAAD Case Rep. 2009;5:150-2.

7.  Genovese MC, van den Bosch F, Roberson SA, Bojin S, Biagini IM, Ryan P, et al. LY2339821, a humanized anti-interleukin-17 monoclonal antibody, in the treatment of patients with rheumatoid arthritis:a phase I randomized, double-blind, placebo-controlled, proof-of-concept study. Arthritis Rheum. 2010;62:929-39.