Adalimumab-induced pustular psoriasis successfully treated with tofacitinib in a patient with ankylosing spondylitis: A brief report
Year: 2026
Type: article
Study design: Case Report
Abstract: Background Tumor necrosis factor (TNF) inhibitors are widely used in the treatment of ankylosing spondylitis (AS); however, paradoxical psoriatic reactions, including pustular psoriasis, represent rare but challenging adverse events that may necessitate treatment discontinuation. Management of such cases is particularly complex due to the risk of disease flare and limited evidence guiding subsequent therapeutic choices. Case Presentation We report the case of a 44-year-old male patient with AS who developed severe pustular psoriasis involving the palms and soles after prolonged adalimumab therapy. Histopathological findings confirmed the diagnosis of pustular psoriasis, leading to discontinuation of adalimumab. Following treatment withdrawal, the patient experienced a marked exacerbation of axial symptoms. Tofacitinib was initiated to achieve control of both articular and cutaneous manifestations. Within one month, significant clinical improvement was observed, accompanied by normalization of inflammatory markers and substantial regression of skin lesions. Sustained remission of both musculoskeletal and dermatologic symptoms was maintained over six months of follow-up. Conclusion This case highlights the potential role of JAK inhibition as an effective therapeutic strategy in patients with AS who develop severe paradoxical pustular psoriasis during TNF inhibitor therapy. Tofacitinib may offer a viable alternative by providing simultaneous control of axial disease activity and cutaneous inflammation
Source: JAAD Case Reports
Authors: Duygu Kurtuluş, İlkin Zindancı
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $750
OpenAlex ID: W7213943489