The following is a summary of “Treatment of Severe Palmoplantar Pustular Psoriasis With Bimekizumab,” published in the December 2023 issue of Dermatology by Passeron, et al.

Palmoplantar pustulosis (PPP) and palmoplantar plaque psoriasis with pustules present significant treatment challenges. Studies indicate the involvement of an interleukin 17 or interleukin 36 loop in these diseases, leading to the induction of palmoplantar pustules. For a study, researchers sought to evaluate the effectiveness of bimekizumab in treating PPP and palmoplantar plaque psoriasis with pustules.

The case series involved 21 adults diagnosed with PPP (11 patients) or palmoplantar plaque psoriasis with pustules (10 patients), treated at 1 of 7 tertiary dermatological centers between September 2022 and June 2023. All patients who received bimekizumab for at least 3 months were included in the analysis. The primary outcome was the posttreatment Investigator Global Assessment (IGA), categorized as 0 (complete clearance), 1 (almost clear), 2 (mild), 3 (moderate), or 4 (severe). Additionally, any changes in joint pain and nail involvement were documented. Tolerance and potential adverse events were also monitored.

In total, 21 patients (mean [range] age, 46 [24-68] years; 19 females) were included, with 11 patients having isolated PPP and 10 patients having palmoplantar plaque psoriasis with pustules. Except for 2 patients who received bimekizumab as their initial systemic therapy, all patients had not responded to at least 1 systemic treatment (median [range], 3 [1-7] treatments), and/or had experienced adverse events leading to treatment discontinuation. Complete clearance (IGA score, 0) was achieved by 17 patients within 1 to 4 months. Three patients attained an IGA score of 1, while 1 patient achieved an IGA score of 2. Among the 3 PPP patients with acrodermatitis continua of Hallopeau, nail involvement showed 50% to 70% improvement after 4 to 6 months of bimekizumab treatment. Two patients with SAPHO syndrome experienced complete clearance of skin lesions alongside improvement in joint pain. Four patients (19%) with candidiasis were effectively treated with oral antifungal agents. No patients discontinued bimekizumab treatment due to adverse events.

The case series suggested that bimekizumab may be a promising treatment for PPP, palmoplantar plaque psoriasis with pustules, and SAPHO syndrome. However, prospective randomized placebo-controlled clinical trials were necessary to confirm these initial promising results.

Reference: jamanetwork.com/journals/jamadermatology/article-abstract/2812629