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Palmoplantar pustulosis: case report A 57-year-old man developed palmoplantar pustulosis (PPP) during treatment with certolizumab pegol for rheumatoid arthritis (RA). The man, who had a history of arterial hypertension and diabetes mellitus, was diagnosed with RA at the age of 50 years. He was initially treated with methotrexate, and had a good tolerance and clinical improvement. However, 5 years later, he was referred for progressive worsening of the inflammation in his hands and persistently high acute phase reactants. Therefore, SC certolizumab pegol 200mg every 2 weeks, was initiated. Within the first 2 months, he achieved good articular and laboratory response. After 3 months of certolizumab pegol treatment, he was admitted to the emergency department for a sudden onset of millimetre-sized, confluent and painless pustular lesions on both his palms and soles of the feet, without any signs of lesions or infection in other locations. Biopsy of a palmar lesion was histopathologically congruous with PPP. Therapy with certolizumab pegol was discontinued, maintaining methotrexate. The man was treated with betamethasone, which was later changed to clobetasol with occlusive dressings and laser treatments. Four months after withdrawing certolizumab pegol, a complete resolution of the lesions was noted. After an observational period of 6 months, he remained in remission, and continued with only methotrexate, with no need to restart biological therapy. Author comment: In conclusion, [certolizumab pegol] may be associated with the development of induced psoriasis, similar to other anti-TNFα drugs, regardless of the indication, with PPP as one of its most common forms of presentation. Villalobos-Sanchez L, et al. Certolizumab pegol-induced palmoplantar pustulosis: A case report and review of the literature. Reumatologia Clinica 15: e163-e165, No. 6, Nov-Dec 2019. Available from: URL: https://doi.org/10.1016/ 803441915 j.reuma.2017.12.004 [Spanish; summarised from a translation] - Spain

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Reactions 21 Dec 2019 No. 1784