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

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

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.

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).
jrd-20-270f1.tif
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).
jrd-20-270f2.tif
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