Refractory Palmoplantar Pustular Psoriasis Treated With High-Dose Ustekinumab After Initial Failure

Area of Science:

• Dermatology
• Gastroenterology
• Immunology

Background:

• Palmoplantar pustular psoriasis (PPPP) presents a significant therapeutic challenge, often proving refractory to conventional treatments.
• Ustekinumab is an interleukin-12/23 inhibitor used for various inflammatory conditions, but treatment failure and tachyphylaxis can occur.

Observation:

• A patient with severe PPPP experienced treatment failure with multiple therapies, including standard-dose ustekinumab.
• The patient later developed inflammatory bowel disease (IBD), necessitating a change in ustekinumab administration.

Findings:

• Restarting ustekinumab with optimized loading doses and maintenance for IBD led to complete resolution of PPPP.
• This case demonstrates successful recapture of ustekinumab response in PPPP despite prior tachyphylaxis.

Implications:

• Optimized ustekinumab dosing strategies may overcome treatment resistance in PPPP.
• Co-existing IBD might influence the efficacy and response recapture of ustekinumab in PPPP patients.
• This finding offers a potential therapeutic avenue for refractory PPPP cases, particularly those with concurrent IBD.