Adalimumab Biosimilar-Induced Severe Paradoxical Palmoplantar Pustulosis in a Patient with Psoriasis and Psoriatic Arthritis Successfully Treated with Ixekizumab

Abstract

Psoriasis vulgaris is a chronic immune-mediated inflammatory disease of the skin. Biologic therapy has been available for more than 10 years and has become one of the standard treatments for patients with moderate to severe psoriasis. Initially, only biologics against tumour necrosis factor alpha (TNF-a) were used, and only later did drugs against different interleukins (ILs), including IL-17 or IL-23, became available. The side effects of biologic therapy include paradoxical adverse events (PAEs), such as palmoplantar pustular reaction, especially with anti-TNF-a drugs. We present the case of a 49-year-old female patient with diabetes and psoriasis and psoriatic arthritis treated with an adalimumab biosimilar who developed a severe PAE of the palmoplantar pustular type. Treatment with adalimumab was stopped and the patient switched to ixekizumab which was successful. When a paradoxical reaction develops during biologic therapy, especially when it is severe as in our patient, switching to another class of biologics is advised.

Deficiency of interleukin‐36 receptor antagonist (DITRA): An analysis of 58 Chinese patients in a tertiary hospital in Taiwan

“…Similar to previous studies, 23 frequent transitions between and co-occurrences of GPP, ACH, PPP and PSO were noticed, but GPP (56.9%) remained the prototypical presentation of DITRA, followed by ACH (27.6%). Patients with other forms of pustular psoriasis usually had ACH developing years afterwards.…”

Biologics as a novel treatment option for palmoplantar pustulosis: a comprehensive review

“…A multicentre, retrospective study demonstrated that 50% of 50 PPP patients treated with adalimumab experienced improvements in disease severity, and 17.6% achieved complete lesion clearance (CC) [ 51 ]. Case reports also suggest adalimumab’s effectiveness in treating PPP [ 88 , 89 ], although it can sometimes induce PPP [ 90 , 91 ].…”

Recalcitrant and persistent adalimumab‐induced paradoxical psoriasiform skin reaction in a rheumatoid arthritis patient successfully treated with upadacitinib

“…Various systemic treatments have also been reported as successful in persisting cases, including IL-17 and IL-23 inhibitors. 3,4 However, these agents may be not effective or F I G U R E 1 Clinical examination shows erythematous-desquamative plaques of the legs (dermoscopy reveals a psoriatic pattern, with uniformly distributed dotted vessels and diffuse white scaling-inset) (A) and plantar areas (with few tiny pustules being visible on dermoscopy-inset) (B). Complete healing of skin manifestations is seen after 3 months of treatment with upadacitinib (C,D).…”