Beyond the Usual Targets: A Case Report of Overcoming IL-23 and IL-17A Biologic Nonresponse in Palmoplantar Psoriasis With Brodalumab.

introductionPalmoplantar psoriasis is a clinically challenging variant of psoriasis in which lesions confined to the palms and soles frequently impair function and prove refractory to conventional therapeutic approaches. A range of therapies, including topical corticosteroids, phototherapy, systemic agents, small molecules, and biologics, are used in palmoplantar psoriasis. Among biologics, those targeting interleukin (IL)-17 and IL-23 are guideline-endorsed for moderate-to-severe disease and are commonly employed in palmoplantar involvement, although responses are often less predictable than in plaque psoriasis. Brodalumab, an IL-17 receptor A (IL-17RA) antagonist, uniquely inhibits signaling from multiple IL-17 family cytokines, which could account for its efficacy in patients who fail other targeted therapies. CASE REPORT: This is a case report on a patient presenting with palmoplantar psoriasis that was resistant to topical and systemic corticosteroids. A 62-year-old White male patient with obesity presented with chronic palmoplantar psoriasis and was unsuccessfully treated with guselkumab and ixekizumab. Disease persistence severely affected the patient's work performance. Brodalumab initiation resulted in complete skin clearance within 3 months with no adverse effects, and the patient resumed working full-time.

conclusionThis case highlights the potential role of IL-17RA blockade in localized, treatment-resistant psoriasis and supports further investigation into its use for palmoplantar disease.