Case Report: Successful treatment of new onset plaque psoriasis with secukinumab in a peritoneal dialysis patient.

Psoriasis is an immune-mediated inflammatory skin disorder associated with systemic complications, including an elevated risk of chronic kidney disease (CKD) and progression to end-stage renal disease (ESRD). Managing psoriasis in patients undergoing peritoneal dialysis (PD) remains challenging, primarily due to contraindications to conventional systemic therapies and the limited evidence regarding biologic agents in this population. We report a case of severe psoriasis successfully treated with secukinumab in a 61-year-old man on PD. The patient was diagnosed with plaque psoriasis six years after dialysis initiation. Although initial symptoms improved with intensified dialysis and topical corticosteroids, the disease subsequently was exacerbated, presenting with extensive lesions and severe generalized pruritus that significantly impaired sleep quality. Secukinumab was initiated at 300 mg subcutaneously weekly for four weeks, followed by a maintenance dose of 300 mg every four weeks. At 12 months, the patient achieved complete clearance of psoriatic lesions with no adverse events or PD-related complications. This case highlights the paradoxical role of dialysis in psoriasis, which may either induce new-onset disease or ameliorate pre-existing lesions. Furthermore, it supports the efficacy and safety of secukinumab for severe psoriasis in PD patients. While IL-17A is implicated in dialysis-induced peritoneal damage, whether IL-17A inhibitors confer protective benefits on peritoneal membrane integrity in this population remains unknown and warrants dedicated investigation. Further studies are urgently needed to establish evidence-based guidelines for secukinumab use in PD patients.