Palmoplantar Psoriasis Research Articles

Palmoplantar Psoriasis Treatment with Topical Roflumilast 0.3%

Palmoplantar psoriasis is a manifestation of psoriasis that includes pustules, scales, and erythematous hyperkeratotic plaques on the palms of the hands and the soles of the feet. Despite being limited to these regions, palmoplantar psoriasis is difficult to treat and imposes a greater level of quality-of-life burden compared to plaque psoriasis. We describe a case of palmoplantar psoriasis refractory topical corticosteroid and dupilumab that was successfully treated with topical roflumilast 0.3% once daily.

Targeted 308-nm Excimer Laser A Safe and Effective Solution for Inflammatory Skin Disorders

Background: The 308-nanometer excimer laser is a targeted ultraviolet B (UVB) light therapy that delivers high-intensity UVB rays directly to affected skin. It has shown considerable efficacy in managing various inflammatory skin conditions, including Psoriasis, Vitiligo, Atopic dermatitis (Eczema), Leukoderma, Alopecia Areata, Chronic recalcitrant dermatitis, Lichen planus, Cutaneous T-cell Lymphoma (e.g. Mycosis fungoides/ Sezary Syndrome), Parapsoriasis, Pityriasis lichenoides chronica, Pruritus, Urticaria pigmentosa, Superficial mycoses (e.g., dermatophytosis [ringworm]. The patient demographic of some of these conditions (e.g. Vitiligo) tends to skew towards patients with darker skin tones. Results: The excimer laser is particularly effective for treating resistant areas, such as the scalp, palmoplantar psoriasis, and hand and foot dermatitis, which often do not respond well to conventional therapies. It has also demonstrated notable success in promoting repigmentation in facial vitiligo, especially in patients with Fitzpatrick skin types IV–VI. Treatment results are typically observed quickly after 5-10 sessions, with sustained improvement and psoriasis clearance evident even at 1-year follow-up. Over the years, access to the Excimer laser procedures has expanded with the availability of these procedures in many private clinics as well as academic facilities. That has increased the availability of the treatment modality and patient choice of therapy. Conclusions: The excimer laser provides a safe, non-invasive treatment option with a strong record of efficacy for multiple inflammatory skin conditions. It is a viable alternative to systemic therapies and can be used either alone or in conjunction with other treatments for optimal patient outcomes.

Holistic approach to treating Vipadika (Palmoplantar Psoriasis) with Ayurvedic Therapies: A Case Report

In Ayurveda all skin disease has been considered under the headings of Kushta. Vipadika is one among such disease which has been included under the heading of Kshudra Kushta. It is characterized by Panipada Sphutanam (fissures), Teevravedana (severe pain) either in palms or soles or in both.[1] Its symptoms can be correlated with palmar-plantar psoriasis which is a chronic skin disease which mainly affects palms and sole region and is characterized by hyperkeratosis, fissures, erythema and occasionally inflammation and pustules. In present, case report a patient with complaint of dryness and cracking of both palms associated with burning and pain in the past 2-3 years, was successfully treated with Shodana (Virechana) and Shamana Aushadhi’s like Manjishthaadi Kashya, Kaishore Gugullu and Jatyadighrit externally for a period of one month. This is an effort to show the brighter side of Ayurvedic treatment not just in alleviating the symptoms but also in improving the immune strength and causing no recurrence of disease. Shodhana helps remove the root cause of the disease, and prevent from recurrence.

Ayurvedic management of Vipadika - A Case Report

Vipadika, categorized as a type of Kshudra Kustha in Ayurveda, presents as a chronic dermatological condition primarily affecting the palms and soles, characterized by symptoms such as Pani-Pada Sphutana (fissures), Teevra Vedana (severe pain), Manda Kandu (itching), and Saraga Pidika (red patches). Vipadika can be correlated to Palmoplantar psoriasis, which is a prevalent chronic inflammatory skin disorder characterized by erythematous plaques affecting the palms and soles significantly impairing daily function and quality of life. Ayurvedic management of Vipadika emphasizes Shamana Oushadhis aimed at pacifying aggravated Doshas, alleviating manifestations of Vipadika. Integral to this approach are Nidana Parivarjana and Pathya Ahara-Vihara Sevana to prevent recurrence. In the present case, a male patient with complaints of dryness, itching, cracking, scaling, and hyperpigmentation of skin of bilateral feet and bleeding from cracks for the last 6 months came to Kayachikitsa OPD and was diagnosed and treated as Vipadika with the Shamana Oushadhis. The patient's condition demonstrated a substantial improvement, with a marked reduction in symptoms evident within 21 days, suggesting effective management of Vipadika through Ayurveda.

Onychoscopy in Palmoplantar Psoriasis: A Comparative Study of Nonpustular Palmoplantar Psoriasis and Palmoplantar Pustulosis

Introduction: Palmoplantar psoriasis (PP) is classified as nonpustular psoriasis (NPPP) or palmoplantar pustulosis (PPP). Objective: We sought to shed light on the phenotypic diversity of nail psoriasis (NP) and conducted a thorough study of the dermoscopic features of nail lesions from patients with NPPP and PPP. Methods: A prospective study included 35 patients with NPPP and 20 patients with PPP who had macroscopic NP changes in at least three of their nails. Demographic and clinical data, such as general characteristics, history, a thorough dermatological examination, and musculoskeletal assessment, were recorded. Each patient had their nails evaluated with video dermoscopy. The statistical analysis was carried out using SPSS software, including descriptive and analytical statistics. Results: Dermoscopic patterns of nail lesions in both groups differed from those seen in psoriasis vulgaris (PV). Trachyonychia was the most common dermoscopic pattern among NPPP patients. Nail bed pustules were found in 75% of the PPP patients, and they were the most common dermoscopic finding identifying PPP nail lesions. In comparison to the NPPP group, patients with PPP had a higher frequency of psoriatic arthritis (PsA) and higher PP and NP severity scores. In the PPP group, all patients with PsA had pustules. Conclusions: NP has a heterogeneous presentation and various clinical manifestations in NPPP, PPP, and PV. The differences in dermoscopic patterns of nail lesions among NPPP, PPP, and PV reflect the diseases' distinct characteristics. A thorough dermoscopic examination of the nails may reveal information about both the underlying pathophysiological pathways and the overall course of psoriasis.

Palmoplantar Psoriasis Resistant to Adalimumab Successfully Treated With Bimekizumab

Palmoplantar Psoriasis Resistant to Adalimumab Successfully Treated With Bimekizumab

Efficacy of Ixekizumab in Chinese Patients with Moderate-to-Severe Psoriasis and Special Body Area Involvement: Sub-analysis of a Randomized, Double-Blind, Multicenter Phase 3 Study.

Special body area involvement is common in psoriasis and can be challenging to treat. We investigated the efficacy of ixekizumab (IXE) in Chinese patients with moderate-to-severe psoriasis and fingernail, scalp, or palmoplantar involvement. A post-hoc sub-analysis of a phase 3 trial, in which patients were randomized to receive placebo, IXE 80mg every 2 (IXE Q2W) or 4 (IXE Q4W) weeks. At Week 12, patients classified as IXE responders [static Physician's Global Assessment (sPGA) score of 0 or 1 [0,1)] were re-randomized (2:1) to IXE Q4W or placebo until Week 60. Efficacy was assessed by body-regionspecific parameters including Nail Psoriasis Severity Index (NAPSI), Psoriasis Scalp Severity Index (PSSI), and Palmoplantar Psoriasis Area Severity Index (PPASI). Of 438 patients, 99.1% (434) had≥1 special area involvement [fingernail (76.5%, 335), scalp (97.3%, 426), palmoplantar (27.9%, 122)]. Significantly greater improvements from baseline in NAPSI score were observed with IXE Q4W and Q2W at Week 12 versus placebo (p<0.001 for both). These improvements were further increased and sustained over 60weeks in IXE Q4W and Q2W responders who were re-randomized to IXE Q4W, who achieved a 77.9% and 89.7% improvement from baseline, respectively, at Week 60. Significantly higher proportions of patients receiving IXE Q4W and Q2W achieved NAPSI 50 at Week 12 versus placebo (44.4%, 36.6% vs. 14.1%; p<0.001 and<0.01, respectively). Similarly, significantly higher proportions of patients receiving IXE Q4W and Q2W achieved PSSI 100 and PPASI 100 at Week 12 versus placebo (60.6% and 65.1% vs. 1.2%, and 67.4%, 84.3% vs. 21.4%, respectively; p<0.001 for all comparisons). Improvements across all outcomes were sustained in patients re-randomized to IXE Q4W until Week 60. IXE led to a rapid onset of action and sustained efficacy over 60weeks in Chinese patients with moderate-to-severe psoriasis and special body area involvement. gov identifier, NCT03364309.

2023 guidelines on the management of psoriasis by the Dermatological Society of Singapore.

Psoriasis is a multisystem, chronic, inflammatory dermatological disease. In routine clinical practice, the management of psoriasis varies significantly. The current study aimed to develop a set of practice guidelines relevant to dermatology practice in Singapore. The Psoriasis Therapeutic Guidelines Workgroup, comprising members of the Dermato-logical Society of Singapore with a subspecialisation in psoriasis, was convened to develop the guidelines. Clinical questions on selected topics were generated and refined by the workgroup. A literature search using PubMed was performed on their assigned topics from June 2013 to December 2023. The articles were included and graded based on the level of evidence. The guidelines address topics ranging from clinical assessment to practical considerations in the management of mild, moderate and severe psoriasis, including delivery of care, referrals to specialists and adherence to treatment. The recommended therapies include phototherapy, methotrexate, acitretin, cyclosporine; apremilast; topical corticoste-roids, calcipotriol, topical calcineurin inhibitors; and biologics (i.e. adalimumab, infliximab, secukinumab, ixekizumab, ustekinumab, etanercept) either in combina-tion or as monotherapy. Common therapeutic concerns relating to biologic use were addressed. Recommendations on generalised pustular psoriasis, palmoplantar pustular psoriasis and psoriatic arthritis were also made. Patients on systemic therapy would receive appropriate vaccine counselling. Therapeutic implica-tions in special populations, such as pregnant/ lactating women, children, the elderly, those undergo-ing surgery and those suffering from specific infections and cancer were addressed. These guidelines were developed for dermatologists, family physicians, rheumatologists and other specialists to support their selection of appropriate management options.

Topical psoriasis therapy: An innovative classic

Introduction. Psoriasis affects various aspects of the quality of life of patients, causing psycho-emotional stress, anxiety and depression, therefore treatment of patients in terms of long-term control is the main goal of therapy.Aim. To study the effectiveness of drugs containing calcipotriol and betamethasone in the treatment of plaque psoriasis of smooth skin, scalp, palmoplantar mild to moderate severity.Material and methods. We observed 59 patients and 32 patients with moderate plaque psoriasis (PASI &gt; 10 and &lt; 20 points). In the groups, patients were randomized into subgroups with mild and moderate severity of psoriasis.Results. In patients with mild and moderate plaque psoriasis, after 4 weeks there was a decrease in the PASI index by 89.1% and 64.1%, respectively, the DLQI index decreased by 53.8% and 61.9%, the sPGA index by 71.8% and 64.9% for mild and moderate degrees, respectively. In patients with mild and moderate palmoplantar psoriasis, after 4 weeks there was a decrease in the PPASI index by 64.2% and 62.1%, respectively, the DLQI index decreased by 56.4% and 56.7%, and the sPGA index by 63.4 % and 66.7% for mild and moderate degrees, respectively. In patients with mild to moderate psoriasis of the scalp, after 4 weeks there was a decrease in the PSSI index by 75.1% and 72.6%, the DLQI index decreased by 64.6% and 69.6%, and the sPGA index by 62.3% and 67.6% for mild and moderate degrees, respectively.Conclusion. A 52-week follow-up demonstrated the effectiveness and safety of therapy with combination drugs (Daivobet® and Xamiol®) in patients with plaque psoriasis, including scalp psoriasis and palmoplantar psoriasis. It also showed a pronounced positive effect on the quality of life of patients, including in terms of long-term control of the disease.

Current and future advances in practice: SAPHO syndrome and chronic non-bacterial osteitis (CNO).

Synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome is a rare, underdiagnosed disease with a wide clinical spectrum. Sterile bone inflammation, predominantly of the anterior chest, and skin manifestations (palmoplantar pustulosis, psoriasis vulgaris and acne) are the key features of SAPHO, which shares certain similarities with SpA. SAPHO is closely related to paediatric chronic non-bacterial osteitis (CNO), a spectrum of autoinflammatory bone diseases. The aetiology of SAPHO is considered multifactorial based on a complex interplay of genetic, immune and infectious factors. Despite the increasing awareness of SAPHO/CNO, diagnostic delay is common, as validated classification and diagnostic criteria are lacking. Treatment of SAPHO represents a challenge and includes anti-inflammatory drugs, antibiotics, bisphosphonates, synthetic conventional DMARDs and off-label use of anti-cytokine biologics and Janus kinase inhibitors. This review summarizes the current diagnostic and practical treatment approach to SAPHO/CNO and highlights the ongoing research endeavours concerning the definition and validation of diagnostic criteria, core domains and treatment.

51214 Deucravacitinib efficacy in palmoplantar and fingernail psoriasis by baseline Psoriasis Area and Severity Index (PASI) and baseline body surface area (BSA) in the phase 3 POETYK PSO-1 and PSO-2 trials

51214 Deucravacitinib efficacy in palmoplantar and fingernail psoriasis by baseline Psoriasis Area and Severity Index (PASI) and baseline body surface area (BSA) in the phase 3 POETYK PSO-1 and PSO-2 trials

54069 Bimekizumab effectiveness in the treatment of palmoplantar psoriasis: a case series

54069 Bimekizumab effectiveness in the treatment of palmoplantar psoriasis: a case series

Palmoplantar psoriasis: A clinicopathological correlation in a tertiary care hospital.

Palmoplantar psoriasis is a clinical variant of psoriasis characterized by well-defined erythematous desquamating plaques on palms and soles, which may or may not include pustules. Hyperkeratotic lesions of palm and sole commonly include Psoriasis, Eczema and Tinea. These conditions often present with overlapping clinical and histopathological features requiring clinicohistopathological correlation for a conclusive diagnosis. The presence of munro's microabscess or spongiform pustule of kogoj differentiates psoriasis of palm and sole from other hyperkeratotic lesions of palm and sole. The objective of this study was to study the clinical and histopathological profile of palmoplantar psoriasis and correlate clinical diagnosis with histopathological diagnosis. A hospital-based, descriptive study was conducted from January 1, 2020, to December 31, 2020. Fifty-two patients were clinically diagnosed as palmoplantar psoriasis with or without involving other parts of body and routine histopathological evaluation was carried out as per standard protocols. Clinically diagnosed 52 cases of palmoplantar psoriasis showed varied histopathology with hyperkeratosis (100%), parakeratosis (100%), regular acanthosis (75%), Supra-papillary thinning (44.2%), spongiosis (65.4%), tortuous vessels in the papillary dermis (78.8%) and mixed inflammatory infiltrates (predominantly lymphocytic-100%), which were observed to be prominent findings in skin biopsies of our patients.Clinicopathological correlation was achieved in 88.5% of cases. This study shows clinically diagnosed palmoplantar psoriasis with histopathological features consistent with palmoplantar psoriasis in 88.5% cases. Thus, clinically inconclusive hyperkeratotic lesions with palmoplantar psoriasis can be diagnosed with histopathological correlation improving the therapeutic intervention.

A randomized phase 3b study evaluating the safety and efficacy of risankizumab in adult patients with moderate-to-severe plaque psoriasis with non-pustular palmoplantar involvement

BackgroundIn plaque psoriasis, palmoplantar areas are more difficult to treat. ObjectiveEvaluate the safety and efficacy of risankizumab (RZB) versus placebo (PBO) for the treatment of palmoplantar psoriasis (PPPsO). MethodsPatients were randomized to RZB or PBO for 16 weeks followed by RZB through week 52. The primary and secondary endpoints were achievement of palmoplantar Investigator’s Global Assessment of “clear” or “almost clear” with ≥2-point reduction from baseline (ppIGA 0/1), achievement of ≥75%, ≥90% and 100% improvement in Palmoplantar Psoriasis Area and Severity Index (PPASI 75, PPASI 90, PPASI 100) and achievement of static Physician Global Assessment of "clear" or "almost clear" with ≥2-point reduction from baseline (sPGA 0/1) at week 16. Safety was based on treatment-emergent adverse events (TEAEs). ResultsRZB demonstrated significant efficacy compared to PBO at week 16 in the patients achieving ppIGA 0/1 (33.3% vs 16.1% [P = .006]), PPASI 75 (42.5% vs 14.9% [P < .001]), PPASI 90 (27.6% vs 5.7% [P < 0.001]), sPGA 0/1 (32.2% vs 11.5% [P < .001]) and PPASI 100 (17.2% vs 1.1% [P < .001]). Results improved through week 52 with no new safety signals. LimitationNo biologic comparator ConclusionsRZB demonstrated safety and efficacy in PPPsO.

Palmoplantar Psoriasis: Epidemiological and Clinical Features and Impact on Quality of Life.

Palmoplantar psoriasis is a rare variant of psoriasis. Its impact on quality of life has been poorly investigated. Our aim was to investigate the prevalence of localized palmoplantar psoriasis (PPP), to assess its severity using the modified Palmoplantar Pustular Psoriasis Area and Severity Index (m-PPPASI), and to evaluate the correlation with the Dermatology Life Quality Index (DLQI). We conducted a descriptive study with prospective data collection from January to June 2021. We enrolled 223 patients with psoriasis. We excluded patients without palmar/plantar involvement and those with a body surface area (BSA) greater than or equal to 10%. We included 33 patients with PPP. This corresponded to a 14.8% prevalence among all psoriasis phenotypes. The mean age was 45 years. The male-to-female ratio was 2.3. Pruritus was present in 27 cases. The mean m-PPPASI was 11.77. The mean DLQI was 8.33. A significant correlation was found between DLQI and m-PPPASI: mean DLQI scores for patients with m-PPPASI less than or equal to 10 and m-PPPASI greater than 10 were 5.6 and 11.3, respectively (P = 0.002). Only 11.8% of patients with m-PPPASI less than or equal to 10 had a DLQI greater than 10, whereas 50% of those with m-PPPASI greater than 10 had a DLQI greater than 10 (P = 0.026). Based on the present work, we confirm that, although affecting a reduced BSA, PPP is a severe form of psoriasis. We consider the m-PPPASI to be a reliable tool which can be used to assess the severity of PPP.

Pediatric SAPHO syndrome with pleural effusion: case report of a unique finding in a rare disease.

Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome is a rare autoinflammatory disease characterized by bone inflammation and skin manifestations including acne, palmoplantar pustulosis, psoriasis, or hidradenitis suppurativa. SAPHO syndrome is considered on the same spectrum as chronic nonbacterial osteomyelitis/chronic recurrent multifocal osteomyelitis (CNO/CRMO), the former often being the nomenclature in adults and the latter in children. The diagnosis is made on patterns of clinical manifestations and is a diagnosis of exclusion. While skin and bone manifestations are commonly described with SAPHO syndrome, pleural involvement is rare, and few cases have been described in the literature, especially in pediatric patients. Herein we present a 14-year-old female with a past medical history of hidradenitis supprtiva, eczema, psoriasis, and a prior episode of culture-negative osteomyelitis who presented to the emergency room with chief complaints of right sided pain with inspiration and back pain. Exam revealed palmoplantar pustulosis, hidradenitis supprativa, psoriasis, and tenderness of vertebrae. Imaging showed a right sided pleural effusion and multiple sites of osteitis. Laboratory evaluation revealed elevated inflammatory markers, an exudative pleural effusion with neutrophilic predominance, and no evidence of malignancy, infection, or immunodeficiency. The patient was diagnosed with SAPHO syndrome and treated with naproxen, methotrexate, and golimumab with significant improvement including resolution of the pleural effusion. Pediatric SAPHO syndrome is a rare disease that classically causes osteitis and skin manifestations. This case highlights that pleural effusion can be a rare manifestation of pediatric SAPHO syndrome. Patients with suspected SAPHO syndrome with respiratory symptoms should be evaluated for pleural effusion.

Use of bimekizumab to treat palmoplantar psoriasis in a patient receiving treatment for disseminated tuberculosis: A Case Report.

Due to their inherent role in immunomodulation, concerns have long existed about the use of biologic therapies in patients with active tuberculosis. Most guidelines currently list active tuberculosis as an absolute contraindication to the use of immunomodulatory therapies. Contrary to this, we present a case of a patient with active, disseminated tuberculosis, safely treated with the IL-17 inhibitor bimekizumab.

Short-term efficacy of tildrakizumab on difficult-to-treat areas: a real-world experience.

Novel biologics targeting the IL23/T-17 axis, such as tildrakizumab, have been developed to treat psoriasis. There is limited evidence on the use of tildrakizumab for the treatment of psoriasis in difficult-to-treat areas. Our aim was to evaluate the short-term efficacy and safety of tildrakizumab in patients with moderate-to-severe psoriasis and with the involvement of difficult-to-treat areas. A multicentric retrospective study was conducted on patients who initiated tildrakizumab between July 2022 and July 2023. Psoriasis Area and Severity Index (PASI), Psoriasis Scalp Severity Index (PSSI), Palmoplantar Psoriasis Area and Severity Index (ppPASI), and Nail Psoriasis Severity Index (NAPSI) were measured at baseline and after 16 weeks. The percentages of achieving a PASI75, PASI90, or PASI100 response were assessed. Dermatology Life Quality Index (DLQI) and Itch Visual Analog Scale (VAS) were measured simultaneously. Data about potential safety issues and adverse events were collected. A total of 76 patients were included, and 59 (77.6%) were affected by psoriasis localized to the scalp (n = 32), palmoplantar locations (n = 13), or nails (n = 14). The mean PASI score decreased from 16.5 ± 9.8 at baseline to 1.9 ± 1.6 after 16 weeks. Tildrakizumab treatment resulted in the improvement of PSSI (19.9 ± 10.7 to 2.7 ± 4.2), ppPASI (15.4 ± 6.9 to 1.9 ± 2.3), and NAPSI (20.3 ± 16.9 to 7.6 ± 10.8) from baseline to 16 weeks, respectively. DLQI and Itch VAS also showed marked improvement. Tildrakizumab is a valuable option for treating difficult-to-treat psoriasis and pruritus, with rapid onset of action.

Disease heterogeneity and molecular classification of inflammatory palmoplantar diseases

Palmoplantar pustulosis (PPP) is an inflammatory disease characterized by relapsing eruptions of neutrophil-filled, sterile pustules on the palms and soles that can be clinically difficult to differentiate from non-pustular palmoplantar psoriasis (palmPP) and dyshidrotic palmoplantar eczema (DPE). We sought to identify overlapping and unique PPP, palmPP, and DPE drivers to provide molecular insight into their pathogenesis. We performed bulk RNA sequencing of lesional PPP (n= 33), palmPP (n= 5), and DPE (n= 28) samples, as well as 5 healthy nonacral and 10 healthy acral skin samples. Acral skin showed a unique immune environment, likely contributing to a unique niche for palmoplantar inflammatory diseases. Compared to healthy acral skin, PPP, palmPP, and DPE displayed a broad overlapping transcriptomic signature characterized by shared upregulation of proinflammatory cytokines (TNF, IL-36), chemokines, and T-cell-associated genes, along with unique disease features of each disease state, including enriched neutrophil processes in PPP and to a lesser extent in palmPP, and lipid antigen processing in DPE. Strikingly, unsupervised clustering and trajectory analyses demonstrated divergent inflammatory profiles within the 3 disease states. These identified putative key upstream immunologic switches, including eicosanoids, interferon responses, and neutrophil degranulation, contributing to disease heterogeneity. A molecular overlap exists between different inflammatory palmoplantar diseases that supersedes clinical and histologic assessment. This highlights the heterogeneity within each condition, suggesting limitations of current disease classification and the need to move toward a molecular classification of inflammatory acral diseases.

Adalimumab induced psoriasis in a Crohn’s disease patient: a case report

Adalimumab is a human monoclonal antibody that selectively targets tumour necrosis factor-alpha (TNF- Alpha), a cytokine involved in the pathogenesis of various inflammatory and autoimmune disorders. Adalimumab has been approved worldwide for the treatment of several chronic immune-mediated diseases, including rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, Crohn's disease, ulcerative colitis, and juvenile idiopathic arthritis. One of the adverse reactions caused by Adalimumab is psoriasis. This study reports the case of a 37-year-old male with palmoplantar psoriasis triggered by adalimumab for treatment of Crohn’s disease. This eruption resisted complete clearance with various potent corticosteroids. The patient was referred back to the treating rheumatologist to possibly change adalimumab to another type of therapy. Keywords: Adalimumab, psoriasis, Crohn’s disease, paradoxical psoriasis.