{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T04:59:24Z","timestamp":1780981164025,"version":"3.54.1"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"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>Acrodermatitis continua of Hallopeau (ACH) is a refractory, chronic, sterile pustular psoriasis predominantly involving the acral regions. Although biologic agents targeting the interleukin-17 (IL-17) pathway have demonstrated clinical promise, systemic administration may induce eczematous eruptions, known as \u201cimmune drift,\u201d due to Th17\/Th2 immune imbalance. This report presents a novel and successful case, being the first to describe a patient with refractory ACH who was successfully treated with local injections of an IL-17 inhibitor, thereby avoiding immune drift. A 13-year-old female patient with ACH showed poor responses to systemic acitretin, upadacitinib, and topical calcipotriol\/betamethasone. After switching to systemic Xeligekimab, her hand and foot pustules improved rapidly, but eczematous eruptions appeared. Subsequently, the treatment was switched to diluted Xeligekimab administered via divided local injections around the lesions on the hands and feet. By week 4, periungual lesions markedly improved; by week 16, erythema and pustules had largely resolved, and scaling significantly improved. The Palmoplantar Pustulosis Area and Severity Index (PPPASI), Dermatology Life Quality Index (DLQI), and Nail Psoriasis Severity Index (NAPSI) all decreased substantially, and no immune drift recurred. This case suggests that local injection of an IL-17 inhibitor may effectively control skin lesions while potentially avoiding systemic immune imbalance, offering a preliminary novel treatment approach for refractory ACH that requires further validation.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1869496","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T04:31:25Z","timestamp":1780979485000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Local injection of an IL-17 inhibitor successfully treats Acrodermatitis continua of Hallopeau and avoids immune shift"],"prefix":"10.3389","volume":"17","author":[{"given":"Yali","family":"Li","sequence":"first","affiliation":[{"name":"Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital","place":["Tianjin, 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