Severe Psoriasis Leading to Scarring Alopecia of the Scalp Responding to Biologic Therapy

A 36-year-old woman with severe scalp psoriasis and psoriatic arthritis experienced progressive hair loss and scarring alopecia despite various treatments. After a two-year treatment hiatus, she was treated with bimekizumab 320 mg every 4 weeks, which led to an improvement in scalp erythema, scaling, and hair density, although she developed bimekizumab-associated eczema managed with dupilumab. Transitioning to maintenance dosing every 8 weeks resulted in disease recurrence, which improved upon returning to the original dosing schedule. This case suggests that bimekizumab, a dual IL-17A/IL-17F blocker, may be effective for psoriatic scarring alopecia, a rare and challenging condition, and highlights the need for further research.