{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T12:46:45Z","timestamp":1770468405856,"version":"3.49.0"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T00:00:00Z","timestamp":1764806400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Neutrophilic dermatoses (NDs) are a heterogeneous group of inflammatory skin disorders marked by dense, sterile neutrophilic infiltrates. Rheumatoid neutrophilic dermatitis (RND), a rare subtype, is uniquely associated with rheumatoid arthritis (RA) and typically presents in patients with severe seropositive disease. Here, we report a rare case of bullous RND in a 67-year-old male with chronic seropositive nodular RA, temporally triggered by the interleukin-6 inhibitor tocilizumab. The patient developed a recurrent bullous eruption following successive tocilizumab infusions, confirmed by histopathology as RND. Despite corticosteroid therapy and colchicine, his symptoms persisted. Discontinuation of tocilizumab and initiation of etanercept resulted in rapid and sustained resolution of both cutaneous and articular symptoms. This case represents only the second reported incidence of tocilizumab-induced RND and one of very few cases demonstrating a steroid-refractory bullous phenotype that responded exclusively to TNF-\u03b1 inhibition. It underscores the complex and sometimes paradoxical effects of biologics, which may both treat and trigger neutrophilic dermatoses. Our findings support the importance of recognising biologic-induced cutaneous adverse effects and tailoring management strategies accordingly. Early identification through skin biopsy, prompt discontinuation of the offending agent, and consideration of targeted immunomodulators such as tumour necrosis factor-alpha inhibitors are critical in managing drug-induced RND. Continued documentation of such cases will enhance understanding of paradoxical inflammatory responses to biologic agents and inform future therapeutic approaches in patients with autoimmune diseases.<\/jats:p>","DOI":"10.1093\/mrcr\/rxaf073","type":"journal-article","created":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T12:55:33Z","timestamp":1764680133000},"source":"Crossref","is-referenced-by-count":2,"title":["Tocilizumab-induced bullous rheumatoid neutrophilic dermatitis: a rare steroid-resistant adverse effect managed with etanercept"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-5108-2491","authenticated-orcid":false,"given":"Thabuna","family":"Sivaprakasam","sequence":"first","affiliation":[{"name":"Internal Medicine Residency, University of South Dakota Sanford School of Medicine , Sioux Falls, SD ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Molly","family":"Lien","sequence":"additional","affiliation":[{"name":"University of South Dakota Sanford School of Medicine , Sioux Falls, SD ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amna","family":"Gill","sequence":"additional","affiliation":[{"name":"Internal Medicine Residency, University of South Dakota Sanford School of Medicine , Sioux Falls, SD ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kayla","family":"Riswold","sequence":"additional","affiliation":[{"name":"Dermatologist and Dermatopathologist, Avera Medical Group , Sioux Falls, SD ,","place":["USA"]},{"name":"Department of Pathology and Internal Medicine, The University of South Dakota Sanford School of Medicine , Sioux Falls, SD ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Fanciullo","sequence":"additional","affiliation":[{"name":"Avera Medical Group Rheumatology , Sioux Falls, SD ,","place":["USA"]},{"name":"Department of Internal Medicine, University of South Dakota Sanford School of Medicine , Sioux Falls, SD ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,12,4]]},"reference":[{"key":"2026011210480296800_ref1","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1016\/j.jaad.2017.11.064","article-title":"Neutrophilic dermatoses: pathogenesis, sweet syndrome, neutrophilic eccrine hidradenitis, and Beh\u00e7et disease","volume":"79","author":"Nelson","year":"2018","journal-title":"J Am Acad Dermatol"},{"key":"2026011210480296800_ref2","doi-asserted-by":"publisher","first-page":"1059","DOI":"10.3389\/fimmu.2019.01059","article-title":"Mechanisms of inflammation in 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treatment","volume":"22","author":"Maalouf","year":"2015","journal-title":"Curr Opin Hematol"},{"key":"2026011210480296800_ref6","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1007\/s12016-012-8351-x","article-title":"Autoinflammatory skin disorders in inflammatory bowel diseases, pyoderma gangrenosum and Sweet's syndrome: a comprehensive review and disease classification criteria","volume":"45","author":"Marzano","year":"2013","journal-title":"Clin Rev Allergy Immunol"},{"key":"2026011210480296800_ref7","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1016\/j.clindermatol.2013.11.004","article-title":"Neutrophilic dermatoses as systemic diseases","volume":"32","author":"Prat","year":"2014","journal-title":"Clin Dermatol"},{"key":"2026011210480296800_ref8","doi-asserted-by":"publisher","first-page":"adv18284","DOI":"10.2340\/actadv.v103.18284","article-title":"Sweet syndrome: clinical presentation, malignancy association, autoinflammatory disorders and treatment response in a cohort of 93 patients with long-term follow-up","volume":"103","author":"Gil-Lianes","year":"2023","journal-title":"Acta Derm Venereol"},{"key":"2026011210480296800_ref9","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1007\/s10067-009-1287-8","article-title":"Interstitial granulomatous dermatitis in rheumatoid arthritis responsive to etanercept","volume":"29","author":"Zoli","year":"2010","journal-title":"Clin Rheumatol"},{"key":"2026011210480296800_ref10","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1007\/s12016-017-8632-5","article-title":"Skin manifestations of rheumatoid arthritis, juvenile idiopathic arthritis, and Spondyloarthritides","volume":"53","author":"Chua-Aguilera","year":"2017","journal-title":"Clin Rev Allergy Immunol"},{"key":"2026011210480296800_ref11","article-title":"Skin manifestations of rheumatoid arthritis. Italian journal of","volume":"245","author":"Lora","year":"2018","journal-title":"Dermatology and Venereology"},{"key":"2026011210480296800_ref12","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1007\/s12016-017-8629-0","article-title":"Inflammatory joint disorders and neutrophilic dermatoses: a comprehensive review","volume":"54","author":"Cugno","year":"2017","journal-title":"Clin Rev Allergy Immunol"},{"key":"2026011210480296800_ref13","doi-asserted-by":"crossref","first-page":"350","DOI":"10.5114\/reum.2019.90363","article-title":"Rheumatoid neutrophilic dermatitis","volume":"57","author":"\u017buk","year":"2019","journal-title":"Reumatologia\/Rheumatology."},{"key":"2026011210480296800_ref14","doi-asserted-by":"crossref","first-page":"e12","DOI":"10.1111\/j.1440-0960.2012.00963.x","article-title":"Rheumatoid neutrophilic dermatosis with tense blister formation: a case report and review of the literature","volume":"55","author":"Fujio","year":"2012","journal-title":"Australas J Dermatol"},{"key":"2026011210480296800_ref15","doi-asserted-by":"crossref","first-page":"1865","DOI":"10.1007\/s40265-017-0829-7","article-title":"Tocilizumab: a review in rheumatoid arthritis","volume":"77","author":"Scott","year":"2017","journal-title":"Drugs."},{"key":"2026011210480296800_ref16","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2025.1470488","article-title":"Update on tocilizumab in rheumatoid arthritis: a narrative review","volume":"16","author":"Parisi","year":"2025","journal-title":"Front Immunol"},{"key":"2026011210480296800_ref17","doi-asserted-by":"crossref","DOI":"10.1111\/dth.14990","article-title":"Does tocilizumab have a role in dermatology? 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