Despite extreme transfusion dependence (>110 cumulative units of red cells and platelets over six years) and persistent bone marrow failure, treatment with Ixekizumab (anti-IL-17A) achieved significant cutaneous improvement, reducing the International Hidradenitis Suppurativa Severity Score (IHS4) from 21 to 11. The gene discussed is IL17A; the disease is hidradenitis suppurativa.