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

Gyun Seop Lim; Hyung Nam Kim; Bo-Bae Kim; Dong Hyun Kim; Yun Sung Kim; Hyun-Sook Kim

doi:10.4078/jrd.2013.20.4.270

Journal List > J Rheum Dis > v.20(4) > 1064059

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Lim, Kim, Kim, Kim, Kim, and Kim: A Case of Psoriasiform Dermatitis Followed by Tumor Necrosis Factor Inhibitor Treated with Phototherapy

Case Report

J Rheum Dis 2013;20(4):270-274.

Published online: 31 August 2013

DOI: https://doi.org/10.4078/jrd.2013.20.4.270

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

Gyun Seop Lim¹, Hyung Nam Kim¹, Bo-Bae Kim¹, Dong Hyun Kim¹, Yun Sung Kim¹, Hyun-Sook Kim²

¹Department of Internal Medicine, The Chosun University College of Medicine, Gwangju, Korea

²Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea

Corresponding to : Hyun-Sook Kim, Department of Internal Medicine, Division of Rheumatology, The Soonchunhyang University Seoul Hospital, 59, Daesagwan-ro, Yongsan-gu, Seoul 140-743, Korea. E-mail : healthyra@schmc.ac.kr

Received 19 March 20132 May 2013 Accepted 4 May 2013

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Although tumor necrosis factor (TNF)-α 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-α antagonist include skin rash, urticaria, lupus like rash, sebor-rheic dermatitis and different kinds of psoriasiform dermatitis. We report a case of psoriasiform dermatitis during TNF-α 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.

Keywords: Phototherapy, Psoriasiform dermatitis, TNF-α antagonist, Rheumatoid arthritis

References

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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).

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