MANCHESTER, ENGLAND — For the first time, a patient being treated with adalimumab for rheumatoid arthritis has developed a subepidermal pustular eruption, wrote Dr. Preeti Athavale in a poster session at the annual meeting of the British Association of Dermatologists.
Cutaneous reactions have been reported previously for the anti-tumor necrosis factor (TNF)-α agents, including injection site reactions and systemic reactions that occur during infusions. However, it had been expected that adalimumab would have fewer side effects than its predecessors, according to Dr. Athavale, of the department of dermatology at Chesterfield (England) Royal Hospital.
The 37-year-old patient had had debilitating rheumatoid arthritis for 20 years, but had no history of skin disease. She had previously received treatment with cyclosporine, infliximab, and etanercept without success. About 8 months after she began taking adalimumab, she developed painful, itchy pustules on her arms, thighs, and chest. These flared approximately 2 days after she received her twice-monthly adalimumab injection and never entirely cleared, said Dr. Athavale.
Biopsy of a pustule and adjacent skin on the arm revealed a subepidermal neutrophilic pustulosis. Immunofluorescence studies looking for evidence of immunoglobulins and complement were negative, and overall, the findings were not consistent with a primary dermatosis.
The adalimumab was stopped 3 months later for lack of efficacy, and the pustular eruption settled within 1 month. It has not recurred, Dr. Athavale reported.
There have been a few reports of skin reactions to adalimumab, mainly injection site reactions and nonspecific rashes. There also has been one case report of an erythema multiforme-like reaction that cleared when the drug was withdrawn (Arthritis Rheum. 2004;50:1690–2).