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Psoriasiform lesions induced by tumour necrosis factor antagonists: a skin-deep medical conundrum
  1. J D Carter1,
  2. H C Gerard2,
  3. A P Hudson2,3
  1. 1
    Department of Internal Medicine, Division of Rheumatology, University of South Florida School of Medicine, Tampa, Florida, USA
  2. 2
    Department of Immunology and Microbiology, Wayne State University School of Medicine, Detroit, Michigan, USA
  3. 3
    Research Service, DVA Medical Center, Detroit, Michigan, USA
  1. Dr J D Carter, Department of Internal Medicine, Division of Rheumatology, University of South Florida School of Medicine, 12901 Bruce B Downs Blvd MDC81, Tampa, Florida 33612, USA; jocarter{at}


Rarely, tumour necrosis factor (TNF)α antagonist therapy has been associated with de novo psoriasiform eruptions. This is unusual in that these same drugs are used to treat psoriasis. Most of these cases involve the palms and soles, yet palmoplantar pustular psoriasis represents only 1.7% of all cases of psoriasis. Keratoderma blenorrhagicum is a psoriasiform rash that occurs primarily on the palms and soles of some patients with reactive arthritis. It is grossly and histologically indistinguishable from pustular psoriasis. Chlamydia trachomatis is a common aetiological agent for reactive arthritis, and in vitro studies have shown that chlamydial replication is inversely proportional to TNFα levels. Three patients taking TNFα antagonists are presented who developed such lesions and who were found to be positive for C trachomatis DNA in the affected skin. It is proposed that these psoriasiform lesions may not be psoriasis, but rather keratoderma blenorrhagicum.

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  • Funding: This study was supported by grants AR-53646 (JDC) and AR-42541 (APH) from the US National Institutes of Health.

  • Competing interests: None declared.

  • Patient consent: Informed consent was received for the publication of the details in this report.

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