Summary
Introduction. Palmoplantar psoriasis is one of the most treatment-resistant forms of the disease. Due to the thick stratum corneum, topical monotherapy is effective in only approximately 27.4% of patients, making systemic or combination therapies necessary for the majority.
Clinical case. A 50-year-old woman with childhood- onset psoriasis experienced a flare in 2013, with lesion spread to palms and soles. Topical treatments and phototherapy were ineffective, and methotrexate was discontinued due to adverse effects. In 2016, biological therapy was initiated with a tumor necrosis factor-α inhibitor, infliximab, followed by etanercept; however, both were discontinued due to insufficient efficacy. From 2018 to 2023, treatment with the interleukin- 12/23 inhibitor ustekinumab resulted in a good clinical response lasting five years, after which the drug’s effectiveness diminished. Between 2023 and 2025, the patient received the interleukin-17 inhibitor ixekizumab, followed by the interleukin-23 inhibitor risankizumab, but no adequate effect was achieved. In 2024, acitretin was added but discontinued due to adverse effects.
Discussion. In the treatment of palmoplantar psoriasis, topical therapy, phototherapy or photochemotherapy are often insufficient, while traditional systemic agents rarely provide a sustained clinical response. When topical treatment, photo(chemo)therapy, and at least one conventional systemic drug are ineffective or not tolerated, biological therapies targeting tumor necrosis factor-α or interleukins 12/23, 23, and 17 are considered.
Conclusions. Despite advances in treatment, palmoplantar psoriasis remains difficult to manage. This case highlights the need for personalized, multimodal approaches combining topical, systemic, and biologic therapies to improve long-term outcomes.
