J Rheum Dis.  2013 Aug;20(4):270-274. 10.4078/jrd.2013.20.4.270.

A Case of Psoriasiform Dermatitis Followed by Tumor Necrosis Factor Inhibitor Treated with Phototherapy

• Lim GS
• Kim HN
• Kim BB
• Kim DH
• Kim YS
• Kim HS

• KMID: 2297545
• DOI: http://doi.org/10.4078/jrd.2013.20.4.270

Abstract

Although tumor necrosis factor (TNF)-alpha antagonist is a successful treatment modality for various autoimmune diseases, including rheumatoid arthritis (RA), ankylosing spondylitis and psoriatic arthritis, many adverse effects have been reported. Cutaneous adverse reactions of TNF-alpha antagonist include skin rash, urticaria, lupus like rash, seborrheic dermatitis and different kinds of psoriasiform dermatitis. We report a case of psoriasiform dermatitis during TNF-alpha antagonist treatment in a 50-year-old woman with RA. The patient has been treated with adalimumab. After 2 months, she developed pruritic erythematous eruption and desquamative lesions on the head and limbs, which were defined as psoriasiform change by a skin biopsy. These skin lesions are successfully treated with combination therapy, including cessation of adalimumab, corticosteroid and phototherapy.

Keyword

Phototherapy; Psoriasiform dermatitis; TNF-alpha antagonist; Rheumatoid arthritis

MeSH Terms

Antibodies, Monoclonal, Humanized
Arthritis, Rheumatoid
Autoimmune Diseases
Biopsy
Dermatitis
Dermatitis, Seborrheic
Exanthema
Extremities
Female
Head
Humans
Middle Aged
Phototherapy
Skin
Tumor Necrosis Factor-alpha
Urticaria
Adalimumab
Antibodies, Monoclonal, Humanized
Tumor Necrosis Factor-alpha

Figure

• 

  Figure 1. After using adalimumab, pruritic desquamation occurred at the right frontal area and right arm with serous discharge (A, D). After using topical steroid, desquamating lesion was not controlled (B). After treatment of systemic steroid and phototherapy, lesions were improved (C, E).

• 

  Figure 2. Microscopically, there are atypical keratinocytes with focally preserved basal layer. Also, there are perivascular lymphocytic infiltration (H&E stain, ×100) (A). Full thickness atypia shows a loss of polarity (H&E stain, ×200) (B).

Reference

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