Severe paradoxical generalized pustular psoriasis induced by adalimumab biosimilar successfully treated with brodalumab

Paradoxical psoriasis is a rare but increasingly recognized adverse effect of anti-TNF-α therapy, characterized by the onset or exacerbation of psoriatic lesions in patients treated for other immune-mediated conditions. We report the case of a 47-year-old woman with chronic plaque psoriasis who dev...

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Main Authors: Angela Fico, Edoardo Mortato, Claudia Paganini, Marina Talamonti, Cosimo Di Raimondo, Dionisio Silvaggio, Luca Bianchi, Marco Galluzzo
Format: Article
Language:English
Published: PAGEPress Publications 2025-05-01
Series:Dermatology Reports
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Online Access:https://www.pagepress.org/journals/dr/article/view/10414
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author Angela Fico
Edoardo Mortato
Claudia Paganini
Marina Talamonti
Cosimo Di Raimondo
Dionisio Silvaggio
Luca Bianchi
Marco Galluzzo
author_facet Angela Fico
Edoardo Mortato
Claudia Paganini
Marina Talamonti
Cosimo Di Raimondo
Dionisio Silvaggio
Luca Bianchi
Marco Galluzzo
author_sort Angela Fico
collection DOAJ
description Paradoxical psoriasis is a rare but increasingly recognized adverse effect of anti-TNF-α therapy, characterized by the onset or exacerbation of psoriatic lesions in patients treated for other immune-mediated conditions. We report the case of a 47-year-old woman with chronic plaque psoriasis who developed severe generalized pustular psoriasis (GPP) after six months of treatment with an adalimumab biosimilar. Given the extent and severity of the eruption and following inadequate response to previous conventional therapies, the patient was treated with brodalumab, an IL-17RA inhibitor. Rapid and complete remission of both pustular and plaque psoriasis was achieved and maintained for over 60 weeks. This case supports the efficacy of IL-17 pathway blockade in managing paradoxical GPP and highlights the importance of prompt recognition and appropriate therapeutic switching in severe biologic-induced psoriasis.
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publishDate 2025-05-01
publisher PAGEPress Publications
record_format Article
series Dermatology Reports
spelling doaj-art-35bbcbc5ea4a4bacae6c8b4e4e984d222025-08-20T02:35:32ZengPAGEPress PublicationsDermatology Reports2036-73922036-74062025-05-0110.4081/dr.2025.10414Severe paradoxical generalized pustular psoriasis induced by adalimumab biosimilar successfully treated with brodalumabAngela Fico0https://orcid.org/0009-0006-6352-4831Edoardo Mortato1https://orcid.org/0009-0008-3763-6922Claudia Paganini2https://orcid.org/0009-0003-8623-777XMarina Talamonti3https://orcid.org/0000-0002-3070-4071Cosimo Di Raimondo4https://orcid.org/0000-0003-4691-9381Dionisio Silvaggio5https://orcid.org/0000-0003-0866-914XLuca Bianchi6Marco Galluzzo7https://orcid.org/0000-0002-3424-5175Department of Systems Medicine, University of Rome “Tor Vergata”Department of Systems Medicine, University of Rome “Tor Vergata”Department of Systems Medicine, University of Rome “Tor Vergata”Dermatology Unit, Fondazione Policlinico “Tor Vergata”Dermatology Unit, Fondazione Policlinico “Tor Vergata”Dermatology Unit, Fondazione Policlinico “Tor Vergata”Department of Systems Medicine, University of Rome “Tor Vergata”; Dermatology Unit, Fondazione Policlinico “Tor Vergata”, RomeDepartment of Systems Medicine, University of Rome “Tor Vergata”; Dermatology Unit, Fondazione Policlinico “Tor Vergata”, Rome Paradoxical psoriasis is a rare but increasingly recognized adverse effect of anti-TNF-α therapy, characterized by the onset or exacerbation of psoriatic lesions in patients treated for other immune-mediated conditions. We report the case of a 47-year-old woman with chronic plaque psoriasis who developed severe generalized pustular psoriasis (GPP) after six months of treatment with an adalimumab biosimilar. Given the extent and severity of the eruption and following inadequate response to previous conventional therapies, the patient was treated with brodalumab, an IL-17RA inhibitor. Rapid and complete remission of both pustular and plaque psoriasis was achieved and maintained for over 60 weeks. This case supports the efficacy of IL-17 pathway blockade in managing paradoxical GPP and highlights the importance of prompt recognition and appropriate therapeutic switching in severe biologic-induced psoriasis. https://www.pagepress.org/journals/dr/article/view/10414Paradoxical psoriasisgeneralized pustular psoriasisadalimumab biosimilarbrodalumab
spellingShingle Angela Fico
Edoardo Mortato
Claudia Paganini
Marina Talamonti
Cosimo Di Raimondo
Dionisio Silvaggio
Luca Bianchi
Marco Galluzzo
Severe paradoxical generalized pustular psoriasis induced by adalimumab biosimilar successfully treated with brodalumab
Dermatology Reports
Paradoxical psoriasis
generalized pustular psoriasis
adalimumab biosimilar
brodalumab
title Severe paradoxical generalized pustular psoriasis induced by adalimumab biosimilar successfully treated with brodalumab
title_full Severe paradoxical generalized pustular psoriasis induced by adalimumab biosimilar successfully treated with brodalumab
title_fullStr Severe paradoxical generalized pustular psoriasis induced by adalimumab biosimilar successfully treated with brodalumab
title_full_unstemmed Severe paradoxical generalized pustular psoriasis induced by adalimumab biosimilar successfully treated with brodalumab
title_short Severe paradoxical generalized pustular psoriasis induced by adalimumab biosimilar successfully treated with brodalumab
title_sort severe paradoxical generalized pustular psoriasis induced by adalimumab biosimilar successfully treated with brodalumab
topic Paradoxical psoriasis
generalized pustular psoriasis
adalimumab biosimilar
brodalumab
url https://www.pagepress.org/journals/dr/article/view/10414
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