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Case Reports
. 2025 Jul 22:13:2050313X251359029.
doi: 10.1177/2050313X251359029. eCollection 2025.

Biologic and small molecule therapies for psoriasis in individuals with Down syndrome: Two cases and a systematic review

Michal Moshkovich  1 , Jonah W Perlmutter  1 , Ronald Vender  2
Affiliations
Case Reports

Biologic and small molecule therapies for psoriasis in individuals with Down syndrome: Two cases and a systematic review

Michal Moshkovich et al. SAGE Open Med Case Rep. .

Abstract

Down syndrome (DS), also known as trisomy 21, is a genetic condition linked to a higher prevalence of skin disorders, including psoriasis, which affects up to 8% of individuals. DS patients with psoriasis present unique management considerations, including a theoretical increased risk of infectious complications with immunosuppressive therapies. This report includes two cases and a systematic review summarizing available evidence on psoriasis characteristics and treatment outcomes in individuals with DS. We report two DS patients with psoriasis demonstrating variable therapeutic responses: one controlled with acitretin and another requiring secukinumab after multiple treatment failures. To contextualize these findings, we conducted a systematic review following PRISMA guidelines, identifying 10 studies comprising 37 DS patients with psoriasis. Methotrexate was the most frequently failed therapy. Biologics targeting IL-17 and IL-23 pathways achieved the highest rates of complete resolution. These findings reflect Th1/Th17-driven inflammation in DS and highlight the need for individualized, pathway-specific management strategies.

Keywords: biologics; down syndrome; psoriasis; small molecules; trisomy 21.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Ronald Vender - Grants/Research Support/Speakers Bureau/Honoraria: AbbVie, Alumis, Amgen, Arcutis, Bausch Health/Valeant, Boehringer Ingelheim, Bristol Myers Squibb, Celltrion, Dermavant, Dermira, DiCE Pharmaceuticals, DiCE Therapeutics, Eli Lilly and Company, Galderma, Incyte, Jamp, Janssen, Leo, Meiji Seika Pharma, Nimbus Therapeutics, Novartis, Pfizer, Sanofi-Aventis/Genzyme, Sandoz, Sun Pharma, Takeda, UCB Pharma, Zai Lab Co. Ltd. The remaining authors Ms. Moshkovich and Mr. Perlmutter have no relevant disclosures.

References

    1. Madani A, Almuhaideb Q. Adalimumab therapy in a patient with psoriasis, down syndrome, and concomitant hepatitis B virus infection. Biologics Targets Ther 2021; 15: 375–378. - PMC - PubMed
    1. O’Connor C, Byrne B, Roche D, et al. Biological and JAK inhibitor therapy outcomes for severe psoriasis in trisomy 21. J Dermatol 2023; 50(10): 1339–1342. - PubMed

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