Figure 5.

Representative images of outcome in case #2; male, aged 53 years with onset of psoriasis at 24 years of age, cigarette smoker with hypertension. In January 2019 he presented with severe chronic plaque psoriasis. He was not responsive to traditional systemic drugs and anti-TNFα (i.e., multidrug resistant). He was treated with secukinumab from 2016 to 2019, with excellent response over the first year of treatment but loss of efficacy occurred from week 64 of treatment, at which point he was switched to guselkumab. Images at different sites are presented for the time points; baseline, week 16, and week 36. After baseline visit (PASI of 42, guselkumab treatment was initiated (induction phase: 100 mg subcutaneously at weeks 0 and 4, and a maintenance dose every 8 weeks thereafter). After 16 weeks, PASI decreased to 3 and at week 36, PASI decreased to 0.