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June 1, 2008

Pyoderma Gangrenosum in a Patient With Seronegative Rheumatoid Arthritis During Therapy With Adalimumab: Toxic Effects of Adalimumab or Failure of Adalimumab to Prevent the Onset of This Phenomenon?

Arch Dermatol. 2008;144(6):817-818. doi:10.1001/archderm.144.6.817

Adalimumab is a recombinant human IgG1 monoclonal antibody specific for tumor necrosis factor α (TNF-α). Pharmacologic blockade of TNF-α has proven beneficial in a variety of chronic inflammatory conditions, including rheumatoid arthritis and psoriasis.1 It has also been successfully used in the treatment of pyoderma gangrenosum,2 a noninfectious skin disorder frequently associated with rheumatoid arthritis, ulcerative colitis, or hematologic malignancy. A growing number of adverse skin reactions to anti–TNF-α agents, including local reactions at the injection site, nonspecific rashes, isolated cases of bullous skin lesions, leukocytoclastic vasculitis,3 and erythema multiforme,4 have been reported. Moreover, development of psoriasis5 during anti–TNF-α treatment has been observed.