{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T18:20:02Z","timestamp":1792002002347,"version":"4.4.0"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>This case report presents the novel and successful use of periungual Xeligekimab injections for managing refractory Acrodermatitis Continua of Hallopeau (ACH), representing the first documented application of this localized administration route for the IL-17A inhibitor. It contributes to the scientific literature by demonstrating a promising alternative therapeutic strategy for treatment-resistant ACH, highlighting the potential for enhanced local efficacy and minimized systemic exposure. The patient was a 36-year-old woman with a two-decade history of ACH affecting her digits, characterized by persistent periungual and subungual erythema, sterile pustules, significant nail plate dystrophy with thickening and fragmentation, and associated digital swelling, tenderness, and restricted motion. Prior therapies, including topical corticosteroids, phototherapy, and systemic tofacitinib, had proven ineffective. Diagnosis was confirmed clinically and supported by MRI, which revealed active bone marrow edema in the distal phalanges. The therapeutic intervention involved initial periungual injections of a diluted Xeligekimab formulation, which led to partial improvement. This was followed by a series of injections using undiluted Xeligekimab (100 mg\/mL). This escalation resulted in marked clinical resolution: complete clearance of pustules and inflammation, healthy nail regrowth, and resolution of digital swelling and pain. Concurrently, the Dermatology Life Quality Index and pain scores dramatically improved, and follow-up MRI showed substantial resolution of the underlying bone marrow edema, confirming the treatment\u2019s efficacy on both cutaneous and deep osseous inflammation.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1753175","type":"journal-article","created":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T06:49:52Z","timestamp":1772520592000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Case Report: Periungual Xeligekimab injection for refractory Acrodermatitis continua of Hallopeau"],"prefix":"10.3389","volume":"17","author":[{"given":"Peng","family":"Cao","sequence":"first","affiliation":[{"name":"Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aijie","family":"Yuan","sequence":"additional","affiliation":[{"name":"Graduate School, Tianjin University of Traditional Chinese Medicine","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingchen","family":"Yang","sequence":"additional","affiliation":[{"name":"School of Nursing, Beijing University of Chinese Medicine","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuning","family":"Zhang","sequence":"additional","affiliation":[{"name":"Graduate School, Tianjin University of Traditional Chinese Medicine","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Tianjin Institute of Integrative Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2025.05.1438","article-title":"Acrodermatitis continua of Hallopeau-clinical review and proposed management algorithm","volume":"93","author":"Iorizzo","year":"2025","journal-title":"J Am Acad Dermatol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2025.1525821","article-title":"Acrodermatitis continua of Hallopeau: a review and update on biological and small molecule targeted immunomodulatory therapies","volume":"16","author":"Sun","year":"2025","journal-title":"Front Immunol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2050313x231180775","DOI":"10.1177\/2050313X231180775","article-title":"Successful treatment of acrodermatitis continua of Hallopeau with tildrakizumab: A case report","volume":"11","author":"Nguyen","year":"2023","journal-title":"SAGE Open Med Case Rep"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1111\/ijd.17036","article-title":"Local injection of micro-dose guselkumab for acrodermatitis continua of Hallopeau after failure of systemic ixekizumab treatment","volume":"63","author":"Wang","year":"2024","journal-title":"Int J Dermatol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1007\/s40265-024-02125-1","article-title":"Xeligekimab: first approval","volume":"85","author":"Blair","year":"2025","journal-title":"Drugs"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1093\/bjd\/ljae062","article-title":"A multicentre randomized double-blind placebo-controlled phase III study of the efficacy and safety of xeligekimab (GR1501) in patients with moderate-to-severe plaque psoriasis","volume":"191","author":"Cai","year":"2024","journal-title":"Br J Dermatol"},{"key":"B7","first-page":"Cd011535","article-title":"Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis","volume":"8","author":"Sbidian","year":"2025","journal-title":"Cochrane Database Syst Rev"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1111\/dth.12899","article-title":"Biologic therapy for acrodermatitis continua of Hallopeau: Successful treatment with secukinumab and review of the literature","volume":"32","author":"Galluzzo","year":"2019","journal-title":"Dermatol Ther"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2024.1338285","article-title":"Successful treatment of acrodermatitis continua of Hallopeau coexisting with generalized pustular psoriasis with spesolimab: a case report","volume":"15","author":"Wen","year":"2024","journal-title":"Front Immunol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2016.5059","article-title":"Secukinumab for acrodermatitis continua of hallopeau","volume":"153","author":"Muggli","year":"2017","journal-title":"JAMA Dermatol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.180086","article-title":"Acrodermatitis continua of hallopeau with psoriatic arthritis","volume":"46","author":"Khosravi-Hafshejani","year":"2019","journal-title":"J Rheumatol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1080\/09546634.2018.1527993","article-title":"Acrodermatitis continua of Hallopeau successfully treated with secukinumab","volume":"29","author":"Balestri","year":"2018","journal-title":"J Dermatolog Treat"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdcr.2017.02.016","article-title":"Acrodermatitis of Hallopeau and erosive oral mucositis successfully treated with secukinumab","volume":"3","author":"Baron","year":"2017","journal-title":"JAAD Case Rep"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.2147\/CCID.S519344","article-title":"Apremilast coadministered with secukinumab for effective treatment of acrodermatitis continua of hallopeau: A case report","volume":"18","author":"Yao","year":"2025","journal-title":"Clin Cosmet Investig Dermatol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1080\/09546634.2019.1628170","article-title":"Treatment of acrodermatitis continua of hallopeau with ixekizumab","volume":"32","author":"Miller","year":"2021","journal-title":"J Dermatolog Treat"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1111\/dth.15383","article-title":"Acrodermatitis continua of Hallopeau successfully treated with ixekizumab: A case report","volume":"35","author":"Battista","year":"2022","journal-title":"Dermatol Ther"},{"key":"B17","first-page":"1047","article-title":"Treatment of recalcitrant acrodermatitis continua of hallopeau with brodalumab","volume":"18","author":"Milani-Nejad","year":"2019","journal-title":"J Drugs Dermatol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1111\/dth.13170","article-title":"Effectiveness of brodalumab in acrodermatitis continua of Hallopeau: A case report","volume":"33","author":"Passante","year":"2020","journal-title":"Dermatol Ther"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1111\/dth.14301","article-title":"Brodalumab in the treatment of recalcitrant acrodermatitis continua of Hallopeau","volume":"33","author":"Bardazzi","year":"2020","journal-title":"Dermatol Ther"},{"key":"B20","doi-asserted-by":"publisher","first-page":"109694","DOI":"10.1016\/j.clim.2023.109694","article-title":"Local injection of micro-dose anti-interleukin-17A antibody for palmoplantar pustulosis: A real-world study","volume":"253","author":"Xia","year":"2023","journal-title":"Clin Immunol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.4103\/ijdvl.IJDVL_124_20","article-title":"Intramatricial low-dose secukinumab injection for nail psoriasis","volume":"87","author":"He","year":"2021","journal-title":"Indian J Dermatol Venereol Leprol"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1159\/000519144","article-title":"Certolizumab pegol: A new therapeutic approach for acrodermatitis continua of hallopeau","volume":"8","author":"Rizzetto","year":"2022","journal-title":"Skin Appendage Disord"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1111\/ced.14933","article-title":"Intramatricial injection of anti-interleukin-17A antibody for six patients with nail psoriasis","volume":"47","author":"He","year":"2022","journal-title":"Clin Exp Dermatol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.3390\/ijms24076761","article-title":"Spontaneous bone marrow edema: perfusion abnormalities and treatment with surgical decompression","volume":"24","author":"Littman","year":"2023","journal-title":"Int J Mol Sci"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/j.jconrel.2021.06.035","article-title":"Strategies for transdermal drug delivery against bone disorders: A preclinical and clinical update","volume":"336","author":"Sharma","year":"2021","journal-title":"J Control Release"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1753175\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T06:49:56Z","timestamp":1772520596000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1753175\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,3]]},"references-count":25,"alternative-id":["10.3389\/fimmu.2026.1753175"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2026.1753175","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,3]]},"article-number":"1753175"}}