Refractory Chronic Plaque Psoriasis and Psoriatic Arthritis Successfully Managed With Combined Secukinumab and Apremilast Therapy: A Case Report

Psoriasis is a chronic, immune-mediated inflammatory skin condition with variable clinical courses and therapeutic responses. We present the case of a 55-year-old female with chronic plaque psoriasis refractory to multiple biologic agents, including conventional systemic immunosuppressants, Janus kinase inhibitors, and interleukin inhibitors. Despite sequential biologic regimens, the patient demonstrated only partial and transient improvement. Given the persistence of severe disease, combination therapy with secukinumab, an IL-17A inhibitor, and apremilast, a phosphodiesterase-4 inhibitor, was initiated. This dual approach resulted in significant clinical improvement and eventual disease resolution, with sustained remission over follow-up. The case highlights the potential role of combination targeted therapy in managing biologic-refractory psoriasis and emphasizes the need for individualized treatment strategies in complex or resistant cases.