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KMID : 1149120190160010023
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Journal of the Korean Society for Psoriasis
2019 Volume.16 No. 1 p.23 ~ p.26
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Paradoxical pustular psoriasis induced by adalimumab in a patient with plaque psoriasis
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An Ji-Hae
Shin Jung-U
Kim Hyun-Jung
Lee Hee-Jung
Yoon Moon-Soo
Kim Dong-Hyun
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Abstract
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Adalimumab is a monoclonal antibody that binds and inactivates tumor necrosis factor-α (TNF-α). Not infrequently, anti- TNF-α treatment can be associated with exacerbations and development of pathologic conditions that are considered to be responsive to TNF-α blockade, including psoriasiform reactions, flares of arthritis and inflammatory bowel, uveitis and other autoimmune diseases. This phenomenon is called ‘paradoxical reaction’. A 64-year-old man presented for erythematous scaly papules and pustules on his palms and soles, which had appeared initially 2 weeks ago. He had been treated with adalimumab for plaque psoriasis during the last 6 weeks and had no previous history of pustular psoriasis. After this episode, adalimumab was discontinued, and the patient started treatment with secukinumab. He also treated with oral cyclosporine 200 mg/day for 13 weeks at the same time, and most lesions disappeared completely. No evidence of recurrence has been observed during 1 year of follow up.
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KEYWORD
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Adalimumab, Anti-tumor necrosis factor-α, Paradoxical reaction, Pustular psoriasis
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