Stellate ganglion block achieves remission of recurrent head-and-neck plaque psoriasis: A case report.

Psoriasis is a chronic immune-mediated inflammatory disease, and recurrent lesions involving the head and neck can be particularly difficult to manage in clinical practice. Herein, we report a case of recurrent head-and-neck plaque psoriasis treated with stellate ganglion block, an autonomic neuromodulatory intervention. A woman in her 40s had a 6-year history of relapsing plaque psoriasis despite treatment with topical calcipotriol and targeted narrowband ultraviolet-B (UV-B) phototherapy. She declined biologic therapy because of safety concerns. She presented with new erythematous, pruritic plaques on the scalp and neck. Physical examination showed well-defined erythematous, scaly plaques on the forehead, retroauricular regions, and neck. Ultrasound-guided stellate ganglion block was performed with 5 mL of 1% lidocaine, injected alternately into the left and right stellate ganglia once daily for 6 consecutive days. Based on the initial response, a second course was administered, and all other psoriasis treatments were discontinued. Pruritus improved substantially within 48 h of treatment initiation, followed by progressive resolution of erythema and scaling. Complete clearance of the lesions was achieved after two courses of stellate ganglion block. No adverse events were observed, and the patient remained in stable remission during 3 months of follow-up. Although limited to a single case, this observation suggests that stellate ganglion block represents a potential adjunctive therapeutic strategy for patients with recurrent head-and-neck plaque psoriasis. Further studies are warranted to define its efficacy, safety, and mechanistic basis.