Secukinumab-Induced Severe Palmoplantar Psoriasis treated with Guselkumab: A Case Report

Secukinumab is a monoclonal antibody targeting interleukin-17A (IL-17A), approved for the treatment of moderate-to-severe plaque psoriasis and psoriatic arthritis. While effective for many patients, it has been associated with paradoxical reactions such as exacerbation of psoriasis or drug-induced dermatitis. This case report presents a unique occurrence of severe palmoplantar psoriasis triggered by Secukinumab in a patient with psoriatic arthritis and multiple sclerosis (MS), necessitating a switch to another biologic therapy.

A 41-year-old female with a complex medical history including MS presented with severe desquamation and erythematous skin lesions on the hands, feet, and legs following treatment with secukinumab for psoriatic arthritis that necessitated discontinuation of secukinumab. A biopsy suggested drug eruption, with a differential diagnosis including palmoplantar pustular psoriasis. After multidisciplinary consultation, treatment was switched to guselkumab, an IL-23 inhibitor, which resulted in clinical improvement.

This case highlights the potential for paradoxical reactions to IL-17 inhibitors and the efficacy of IL-23 inhibitors as an alternative therapy. Multidisciplinary approach was crucial for optimal patient management.