We observed a remarkable response to spesolimab with an almost resolution of pustules in 12 h in one patient (Figure 1), two patients achieved resolution of pustules in 24 h, one patient is in 48 h, one patient is in 96 h. It is important to point out that PV lesions appeared in two out of the five patients (patient 3 and patient 4) during the observation period after the resolution of pustules. Patient 3 was treated with acitretin 30 mg twice daily orally and patient 4 treated with methotrexate 10 mg once weekly orally to treat the PV lesions after 4 weeks of spesolimab therapy.