Local injection of micro‐dose guselkumab for palmoplantar pustulosis after partial failure of systemic ixekizumab treatment

Abstract We present a palmoplantar pustulosis case partially resistant to systemic IL‐17A inhibitor (ixekizumab) treatment, and then receiving a local injection of 0.1 mL micro‐dose (1 mg) IL‐23 inhibitor (guselkumab) every 4 weeks for four times. The paradoxical lesion disappeared rapidly following local injection and there was no recurrence after 8 weeks of drug withdrawal. This is the first clinical report on the treatment of palmoplantar pustulosis by local injection of micro‐dose guselkumab.