Title pageManuscript TitleDifferential Response of Nail Psoriasis to IL-17 Inhibitors: A Case Reportauthor nameDong Jiang, Yu Lu, Yi-Yu Guo, Jin-Hong Ge, Yun-Peng Gao, Deng-Ke Yangauthor affiliation：Department of Dermatology, Kunming Municipal Hospital of Traditional Chinese Medicine , Kunming, 650011, People’s Republic of ChinaCorrespondceDeng-Ke Yang, Department of Dermatology, Kunming Municipal Hospital of Traditional Chinese Medicine, No. 2628 of Xiangyuan Street, Chengong District, Kunming,650011,Yunnan Province, People’s Republic of China, Tel +86 15877974436, Email 523687402@qq.comFundingNo sources of funding were declared for this study.Conflict of InterestNone declared.AuthorshipDong Jiang participated in the conceptualization of the study and was responsible for writing the original draft.Yu Lu was involved in the conceptualization process, contributing ideas and perspectives that helped shape the overall direction of the study.Yi-Yu Guo provided the necessary resources, which include access to research materials, equipment, or data sources that were crucial for the execution of the study.Jin-Hong Ge carried out the investigation, through fieldwork, data collection to gather information relevant to the study.Yun-Peng Gao was in charge of visualization to present the data and findings in a more accessible way.Deng-Ke Yang supervised the entire study, ensuring that the research was conducted in accordance with the established goals and ethical standards. Additionally, Deng - Ke Yang reviewed and edited the manuscript, providing valuable feedback to improve the quality and clarity of the written work.All authors reviewed and approved the final manuscript.ConsentWritten consent has been obtained from the patient for the treatment of psoriasis with biological agents. And written permission to publish the patient’s case and photographs was acquired.Key Clinical MessageA female with moderate-to-severe plaque psoriasis and nail psoriasis demonstrated a discordant therapeutic response to two IL-17 inhibitors. Initial treatment with secukinumab achieved complete skin clearance by 12 weeks but showed no improvement in nail psoriasis until 30 weeks of use. Switching to ixekizumab resulted in rapid resolution of residual nail psoriasis disease alongside sustained cutaneous control, maintained through 24-month follow-up. This case highlights potential mechanistic differences between IL-17-targeted biologics in addressing psoriatic nail pathology.Keywords ：Psoriasis, Nail psoriasis, Biologics, Secukinumab, Ixekizumab