Etanercept-induced lichenoid reaction pattern in psoriasis.

Area of Science:

• Dermatology
• Immunology

Background:

• Psoriasis is a chronic autoimmune condition requiring effective treatment.
• Biologic therapies, such as etanercept, target tumor necrosis factor alpha (TNF-alpha) for severe psoriasis.
• Treatment failure with conventional therapies necessitates exploring alternative options.

Observation:

• A patient with severe psoriasis, refractory to traditional treatments, received subcutaneous etanercept (25 mg twice weekly).
• Initially responsive, the patient developed a distinct eruption after 5 weeks.
• The eruption presented as sharply demarcated, purple, erythematosquamous plaques on the hands, wrists, and fingers.

Findings:

• Histopathological examination revealed apoptotic cells and basal vacuolization.
• The histology was consistent with moderately active psoriasis.
• Discontinuation of etanercept led to a gradual resolution of the cutaneous eruption.

Implications:

• This case highlights a potential lichenoid drug reaction associated with anti-TNF-alpha therapy.
• Clinicians should be aware of this adverse effect when prescribing etanercept for psoriasis.
• Recognizing and managing this reaction is crucial for patient care and treatment adherence.