Skin reaction to adalimumab

Area of Science:

• Immunology
• Dermatology
• Rheumatology

Background:

• Tumor necrosis factor alpha (TNFalpha) inhibitors like etanercept and infliximab are effective for autoimmune disorders such as rheumatoid arthritis.
• Immune-mediated side effects, including cutaneous reactions, can occur with these biologic therapies.
• Adalimumab is a monoclonal antibody targeting TNFalpha used in treating rheumatoid arthritis.

Observation:

• A case report details a patient with rheumatoid arthritis experiencing an erythema multiforme-like skin reaction.
• The reaction manifested after the sixth adalimumab injection, affecting palms, soles, and the injection site.
• Concomitant use of methotrexate and leflunomide did not alter the reaction's course after adalimumab discontinuation.

Findings:

• The observed skin reaction was clinically consistent with erythema multiforme.
• Discontinuation of adalimumab therapy resulted in a rapid and significant improvement of the cutaneous reaction.
• No alternative pathogenetic mechanisms were identified, and other immunomodulatory drugs were continued.

Implications:

• This case suggests adalimumab can induce specific cutaneous adverse reactions, mimicking erythema multiforme.
• Clinicians should consider adalimumab as a potential cause for such dermatological side effects in rheumatoid arthritis patients.
• Early recognition and discontinuation of adalimumab may be crucial for managing these immune-mediated skin reactions.