Chronic Plaque Psoriasis With Persistent Facial Involvement Successfully Treated With Risankizumab: A Case Report

TL;DR

A 37-year-old man with severe chronic plaque psoriasis, including persistent facial symptoms, achieved significant improvement with risankizumab and additional treatments.

Contribution

Demonstrates successful treatment of persistent facial psoriasis using risankizumab and adjunct therapies in a challenging case.

Findings

Risankizumab led to near-complete systemic clearance of chronic plaque psoriasis.

Persistent facial erythema was managed with topical therapy and pulsed dye laser treatment.

The case highlights the need for individualized, multimodal treatment strategies for facial psoriasis.

Abstract

Chronic plaque psoriasis is a common immune-mediated inflammatory skin disease; however, facial involvement is relatively uncommon and may present diagnostic and therapeutic challenges. Facial psoriasis can mimic other inflammatory dermatoses and may demonstrate variable responses to systemic therapy. We report a case of a 37-year-old male with chronic plaque psoriasis who presented with extensive plaques involving the elbows and knees, along with diffuse, generalized facial erythema. The patient had severe disease with extensive body surface area involvement, reflected by a Psoriasis Area and Severity Index (PASI) score of approximately 50. Histopathological examination of skin punch biopsies confirmed the diagnosis of psoriasis. Initial treatment with systemic cyclosporine resulted in partial improvement. Due to persistent disease activity and the need for long-term control, therapy was escalated to risankizumab, leading to near-complete systemic clearance. Despite excellent overall disease control, residual facial erythema persisted and was managed with topical therapy and adjunctive pulsed dye laser treatment, selected to target persistent vascular erythema. This case highlights the site-specific variability in treatment response observed in facial psoriasis and underscores the importance of individualized, multimodal management strategies to optimize both clinical and psychosocial outcomes.

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