Pityriasis Rubra Pilaris, Refractory to IL-17A Inhibition, with Rapid Improvement Following IL-17A/IL-17F Blockade by Bimekizumab
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Keywords
PRP, pityriasis rubra pilaris, Bimekizumab, erythroderma
Abstract
Introduction: Pityriasis rubra pilaris (PRP) is a rare inflammatory skin disorder which can severely affect patient quality of life. While there are no FDA-approved therapies for PRP, methotrexate and acitretin are often used as first line treatments. Recent analyses have implicated dysregulation of the IL23/IL17 axis in PRP pathogenesis and the use of biologics for severe cases have been reported in the literature.
Case Report: We report the case of a male in his thirties who presented with PRP refractory to a second course of secukinumab. Physical exam revealed diffuse salmon-colored hyperkeratotic patches coalescing to cover his entire body (BSA >95%). The patient was started on combination therapy with acitretin and bimekizumab. The patient recovered rapidly, with near total resolution of his skin findings four weeks after beginning treatment.
Discussion: Unlike earlier biologics targeting IL-17, bimekizumab has activity on IL-17F in addition to IL-17AF and IL-17A. The efficacy of bimekizumab in this case may signify an important role for IL-17F in PRP pathogenesis. Bimekizumab may offer improved efficacy for the treatment of pityriasis rubra pilaris (PRP) in patients who do not respond to other therapies.
References
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