# Case Report: Successful treatment of guselkumab in a patient with verrucous psoriasis unresponsive to secukinumab

## TL;DR

A patient with severe psoriasis unresponsive to one treatment improved significantly after switching to guselkumab.

## Contribution

Demonstrates guselkumab's effectiveness in treating refractory verrucous psoriasis.

## Key findings

- Verrucous psoriasis lesions worsened with secukinumab but improved with guselkumab.
- Complete resolution of leg plaques occurred within six months of guselkumab treatment.
- Trunk and limb plaques also showed significant improvement with guselkumab.

## Abstract

A 77-year-old Chinese male with a 10-year history of plaque psoriasis had recurrent episodes of symmetric hypertrophic verrucous plaques in the lower legs. The patient was monitored for the evolution of the disease over two years before he came to our attention. Because the lesions were resistant to topical glucocorticoids and vitamin D3 at another dermatological center, the patient was treated with secukinumab for one year. However, the verrucous lesions further worsened, and the patient visited the outpatient department of our hospital in March 2023. Treatment with guselkumab was started. It immediately attenuated the plaques of the trunk and limbs. Surprisingly, the verrucous plaques of both legs showed complete resolution in 6 months.