Apremilast
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Paradoxical generalised pustular psoriasis: case report A 33-year-old man developed paradoxical generalised pustular psoriasis following treatment with apremilast. The man had a 10 year history of generalised pustular psoriasis and psoriasis vulgaris. He had been receiving infliximab or adalimumab for 2 years, and remained in clinical remission. He received apremilast [route not stated] at a graduated dosing i.e 10mg at day 1, 10mg+10mg at day 2, 10mg+20mg at day 3, 20mg+20mg at day 4, 20mg+30mg at day 5. Following the treatment he presented with overlying painful sterile pustules sized 2mm to 3mm and erythematous skin involving the entire body. Physical examination revealed erythema with superficial scale involving about 70% of the body surface area. The pustules developed at the edges of erythematous plaques or over erythematous skin. Laboratory findings as follows; leucocytosis (white blood cell count 17.24 x 109/L with 14.36 x 109/L neutrophil granulocytes), platelet count 244 x 109/L, haemoglobin 144 g/L, alanine aminotransferase 24 IU/L, high-sensitivity C-reactive protein 74.34 mg/L, aspartate amino transferase 17 IU/L, erythrocyte sedimentation rate 36 mm/h, tumor necrosis factor (TNF)-a 7.0 pg/mL, interleukin (IL)-6 80.7 pg/mL and urinary protein 0.3 g/L. He had a score of 8 on severity rating scale for generalised pustular psoriasis. He was suspected with apremilast induced paradoxical generalised pustular psoriasis The man, received treatment with adalimumab. Consequently, he had a complete remission in 8 weeks. Wang W-M, et al. Recurrent generalized pustular psoriasis possibly triggered by apremilast. Chinese Medical Journal 133: 1259-1260, No. 10, May 2020. Available from: 803504614 URL: http://doi.org/10.1097/CM9.0000000000000795
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Reactions 3 Oct 2020 No. 1824
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