TNF-α inhibitors (anti-TNF-α) are agents increasingly used in the treatment of rheumatic diseases resistant to classical disease-modifying treatment and they provide significant improvement of disease activity. However, these agents have many cutaneous side effects including psoriasis. Numerous reports of the induction or worsening of psoriasis in patients treated with TNF antagonists indicate that this is not a rare phenomenon. In this study, we present a patient with ankylosing spondylitis who developed palmoplantar pustular psoriasis after receiving anti-TNF-α therapy for 4 months.

Diabetic foot ulcers are the most common chronic and serious complication of diabetes. Diabetic foot ulcers are associated with increased morbidity, impaired quality of life, substantial treatment costs and high rates of lower extremity amputations. Management of diabetic foot ulcers include conventional treatments such as patient education, preventive measures, treatment of concomitant infection, local surgical debridement as well as alternative treatments such as hyperbaric oxygen therapy and negativepressure wound therapy. Here, we report a case of diabetic foot ulcer treated with extracorporeal shock wave therapy (ESWT). We applied ESWT every other day for a total of 9 sessions to a 65-year-old male patient with a history of diabetes mellitus for 15 years and insulin use for treatment of a 2.3 x 3.8 cm wound in the lateral side of his right foot which was present for six months. ESWT was applied with 100 shocks per session for each square centimeter of the wound with a frequency of 4 Hz at 2 bar pressure. No serious adverse reactions or complications occurred during the course of treatment. At the posttreatment follow-up visit at 3 months, a significant reduction in perceived pain and a decrease in the wound size (to 1.5 x 2.2 cm) and depth were observed. We believe that ESWT is an inexpensive, easy to administer and effective treatment modality for management of diabetic foot ulcers which are associated with high costs, treatment challenges, and require amputation in most patients.