Dramatic remission of chronic psoriasis after the treatment of sleep apnea syndrome: an holistic approach of psoriatic disease

A 49-year old male presented cutaneous psoriasis vulgaris since the age of 24. He had a history of class I obesity and dyslipidemic syndrome. For his cutaneous psoriasis, he’d been treated with topical steroids, ciclosporin 3mg/day, methotrexate 15mg/week and PUVAtherapy without any satisfying improvement. At the age of 35, he presented with severe obstructive sleep apnea with more than 60 events per hour during nocturnal polysomnography. Cutaneous examination showed psoriatic lesions covered a large extent of his body. Continuous positive airway pressure therapy and weight loss were recommended. After 3 months, the number of breathing pauses during sleep started to decline and the psoriasis patches appeared thinner. After 6 months the number of breathing pauses decreased to less than 10 per hour. The healing process of the psoriasis lesions continued and the patient was advised to stop using topical steroid after 7 months from starting continuous positive airway pressure therapy. No psoriasis lesions were noted over a 15 year follow-up.