Eruption of Generalized Pustular Psoriasis Following Initiation of Adalimumab for Hidradenitis Suppurativa: A Case Report.

Rarely, tumor necrosis factor (TNF)-α inhibitors can paradoxically induce eruptions of psoriasis with generalized pustular psoriasis being among the least common presentations. We report a patient who presented with a generalized pustular eruption following adalimumab therapy for hidradenitis suppurativa (HS). The diagnosis of generalized pustular psoriasis was confirmed with a biopsy showing neutrophilic spongiosis and intraepidermal pustulosis. We discuss the role of tumor necrosis factor in psoriasis while describing possible mechanisms for this paradoxical reaction. Additionally, we discuss treatment options while considering the severity of the eruption and the underlying disease being treated with the tumor necrosis factor inhibitor.