Successful bimekizumab treatment for palmoplantar psoriasis in skin of color

Summary: Abstract Body: Introduction: Palmoplantar psoriasis (PPP) is a localized form of psoriasis affecting the palms and soles, causing significant itching, pain, and functional impairment. It is characterized by well-defined erythematous plaques with scaling and hyperkeratosis, sometimes with pustules, accounting for 3-4% of all psoriasis cases.This report describes an African American male with refractory PPP successfully treated with bimekizumab, demonstrating its efficacy in managing challenging cases. Case Report: A 78-year-old African American male with a history of hypertension, hyperlipidemia, Type 2 Diabetes Mellitus, and coronary artery disease presented with an eight-month history of worsening itchy, painful, scaly palmoplantar plaques and fissures. Baseline labs were normal. He failed multiple treatments, including topical therapies (triamcinolone .1%, clobetasol .05%, tapinarof, roflumilast), biologics (secukinumab, adalimumab), and four prednisone courses, which provided temporary relief but led to rebound flares once tapered. The patient was started on bimekizumab (320 mg every four weeks), an IL-17A/IL-17F inhibitor. At one month, he reported significant resolution of scaling and cracking skin, near-complete clearance of plaques, marked improvement in itching and joint discomfort, and no adverse effects. Discussion: This case highlights the challenges of managing refractory PPP and the limitations of conventional therapies. In patients with skin of color, subtle erythema complicates the diagnosis, and corticosteroid use can lead to postinflammatory hyperpigmentation. This patient’s response to bimekizumab underscores the value of targeting immune pathways in refractory cases and the risks of long-term corticosteroid use. Bimekizumab offers a promising option for refractory PPP, providing symptom relief and a strong safety profile, especially for patients with skin of color who may have unique immune risks. Emily Tocco¹, Margaret Mercante¹, Diego Dasilva² 1. University of Virginia School of Medicine, Charlottesville, VA, United States. 2. Forefront Dermatology, Virginia Beach, VA, United States. Clinical Research: Epidemiology and Observational Research