Dermatology: Practical and Conceptual Research Letter | Dermatol Pract Concept. 2024;14(4):e2024244 1 Palmoplantar Psoriasis Resistant to Adalimumab Successfully Treated with Bimekizumab Emanuele Trovato1, Martina Dragotto1, Eugenio Capalbo1, Pietro Rubegni1 1 Unit of Dermatology, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy Key words: Psoriasis, Face, Biologics, Tildrakizumab Citation: Trovato E, Dragotto M, Capalbo E, Rubegni P. Palmoplantar Psoriasis Resistant to Adalimumab Successfully Treated with Bimekizumab. Dermatol Pract Concept. 2024;14(4):e2024244. DOI: https://doi.org/10.5826/dpc.1404a244 Accepted: May 15, 2024; Published: October 2024 Copyright: ©2024 Trovato et al. This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Funding: None. Competing Interests: Emanuele Trovato has intermittent project focused consulting and/or advisory relationships or/and travel-congress support with Eli-Lilly, Novartis, Janssen-Cilag, Abbvie, Almirall without any impact on the present manuscript. Martina Dragotto, Eugenio Capalbo and Pietro Rubegni have no conflict of interest. Authorship: All authors have contributed significantly to this publication. Corresponding Author: Emanuele Trovato, MD, Unit of Dermatology, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy. Phone: +39-0577 585428. Fax: +39 0577 44238 E-mail: emanuele.trovato@unisi.it Introduction Palmoplantar psoriasis (PPP) can significantly impair a patient’s quality of life, and it also tends to be resistant to conventional therapies [1]. This condition is therefore of- ten difficult to diagnose and treat. Often a misdiagnosis of allergic contact dermatitis or keratoderma leads the patient to long courses of local and systemic steroid therapy, with no benefit. To date, several real-life experiences of PPP treated with biologic and systemic drugs have been reported. How- ever, data with bimekizumab are still lacking. Case Presentation We report the case of a 68-year-old man with plantar and palmar hyperkeratosis that had been present for about a month despite therapy with biosimilar adalimumab started in 2021. The patient has a history of diabetes mellitus, hypercholesterolemia, and arterial hypertension. Psoriasis was diagnosed about 20 years earlier, and he had already been treated with cyclosporine and acitretin. In addition, the patient was already applying local therapy with 10% salicylic acid in occlusion, without benefit. The patient was very concerned about the worsening of his condition despite therapy with adalimumab and frustrated about the invalida- tion of his daily activities. On dermatological examination, the patient had significant palmar and plantar hyperkerato- sis, nail involvement with the presence of distal subungual hyperkeratosis, pitting, and splinter hemorrhages (Psoriasis Area and Severity Index [PASI] 9; moderate PP-PGA; Nail Psoriasis Severity Index [NAPSI] 85; Dermatology Life Qual- ity Index [DLQI] 24) (Figure 1). The patient reported intense associated painful and itchy symptoms. A microscopic ex- amination ruled out possible concomitant mycosis. In agree- ment with the patient, we started therapy with bimekizumab 320 mg according to the induction and maintenance dosage 2 Research Letter | Dermatol Pract Concept. 2024;14(4):e2024244 schedule. The patient was prescribed topical emollients to reduce painful symptoms. Eight weeks later, we noted a marked improvement with almost complete resolution of skin manifestations, with persistence of mild hyperkeratosis on the right foot and the left palm (Figure 2). Given the short follow-up, it was possible to show just a mild improvement on nails (PASI 2; mild PP-PGA; NAPSI 68; DLQI 2). The patient also reported that he had not applied local emollients and that he had already noticed a progressive clinical im- provement in the first two weeks. The patient is still in ther- apy with complete resolution at last follow-up visit. Conclusion Bimekizumab is a humanized IgG1 monoclonal antibody di- rected against IL-17A and IL-17F. Data from phase III clini- cal trials evaluated and assessed its safety and effectiveness in moderate-to-severe psoriasis. Real-life data on patients with psoriasis in particular sites or severe forms treated with bi- mekizumab are reported in the literature [2-6]. Within this cohort, patients with psoriasis at particular sites were also involved, although post-hoc analyses only on these patients were not performed. In our case, it is interesting to empha- size the rapidity with which the response was achieved, re- sulting in a fully satisfactory outcome for both patient and physician and limiting the use of local therapies. It is also crucial to emphasize the impact on patient quality of life, with a fairly complete reduction in DLQI in eight weeks. Undoubtedly, further studies and data are needed to confirm the efficacy and safety of bimekizumab in real life, especially in patients with PPP. References 1. Trovato E, Rubegni P, Prignano F. Place in therapy of anti-IL-17 and 23 in psoriasis according to the severity of comorbidities: a focus on cardiovascular disease and metabolic syndrome. Expert Opin Biol Ther. 2022 Dec;22(12):1443-1448. DOI: 10.1080/14712598.2022.2093106 2. Valenti M, Gargiulo L, Ibba L, Pavia G, Narcisi A, Costanzo A. Sub-erythrodermic psoriasis successfully treated with bime- kizumab: A case report. Dermatol Ther. 2022;35(12):e15952. DOI:10.1111/dth.15952 3. Megna M, Picone V, Ventura V, et al. A case of scalp psoriasis resistant to ixekizumab treated with bimekizumab. JAAD Case Rep. 2023;38:123-126. DOI:10.1016/j.jdcr.2023.05.043 Figure 1. Palmar and plantar hyperkeratosis, nail involvement with the presence of distal subungual hyper- keratosis, pitting, and splinter hemorrhages (PASI 9; moderate PP-PGA; NAPSI 85). Figure 2. Almost complete resolution of skin manifestations with persistence of mild hyperkeratosis on the right foot and the left palm (PASI 2; mild PP-PGA; NAPSI 68). Research Letter | Dermatol Pract Concept. 2024;14(4):e2024244 3 6. Gargiulo L, Narcisi A, Ibba L, et al. Effectiveness and safety of bimekizumab for the treatment of plaque psoriasis: a real-life multicenter study-IL PSO (Italian landscape psoriasis). Front Med (Lausanne). 2023 Aug 8;10:1243843. DOI: 10.3389/fmed .2023.1243843. 4. Megna M, Battista T, Potestio L, et al. A case of erythrodermic psoriasis rapidly and successfully treated with Bimekizumab. J Cos- met Dermatol. 2023;22(3):1146-1148. DOI:10.1111/jocd.15543 5. Passeron T, Perrot JL, Jullien D, et al. Treatment of Severe Palmo- plantar Pustular Psoriasis With Bimekizumab. JAMA Dermatol. 2023 Dec 6:e235051. DOI: 10.1001/jamadermatol.2023.5051.