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Volume 4, Issue 5, Pages 500-505 (June 2018) Secukinumab in pityriasis rubra pilaris: A case series demonstrating variable response and the need for minimal clinical datasets Tevi Wain, MBBS, Bonita Choy, MBBS, Andrew C. Satchell, MBBS, FACD, Jane A. Woods, MBBS, FACD, John W. Frew, MBBS, FACD JAAD Case Reports Volume 4, Issue 5, Pages 500-505 (June 2018) DOI: 10.1016/j.jdcr.2018.02.007 Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 1 Histopathology of patients included in this case series. Patient A (A and B), patient B (C and D), and patient C (E and F). A, Hyperkeratosis with moderate irregular acanthosis and a moderate perivascular inflammatory infiltrate in the papillary dermis. B, Alternating orthokeratosis and parakeratosis with thickened suprapapillary plates. C, Irregular acanthosis with acantholysis. D, Orthokeratosis and parakeratosis. E, Compact orthokeratosis with focal parakeratosis. F, Some focal acantholysis is evident with perivascular lymphocytic infiltrate. (A-F, Hematoxylin eosin stain; Original magnifications: A, ×40; B, ×200; C, ×20; D, ×40; E, ×100; F, ×100.) JAAD Case Reports 2018 4, 500-505DOI: (10.1016/j.jdcr.2018.02.007) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions

Fig 2 Variability in response to secukinumab for clinically and histologically diagnosed PRP. A, Patient A week 0. B, Patient A week 24. C, Patient B week 0. D, Patient B week 8. E, Patient C week 0. F, Patient C week 8. Patient B had paraneoplastic PRP secondary to CLL and had only limited response to secukinumab over a 6-month period. Patient A had rapid and complete response with no evidence of disease recurrence up to 6 months after cessation of secukinumab. Patient C had paradoxical worsening of disease and ceased treatment at week 8. JAAD Case Reports 2018 4, 500-505DOI: (10.1016/j.jdcr.2018.02.007) Copyright © 2018 American Academy of Dermatology, Inc. Terms and Conditions