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Tumor necrosis factor-alpha inhibitors are commonly used for the treatment of moderate-to-severe psoriasis; however, paradoxical psoriatic eruptions are a well-recognized adverse effect. There are no validated guidelines to manage this. We present the case of a 48-year-old woman with severe pustular psoriasis who developed acute paradoxical reactions after her first two infusions of infliximab, requiring hospitalization. She achieved disease control after transitioning to secukinumab, an interleukin-17 inhibitor. This case highlights the importance of early monitoring for paradoxical reactions in patients with severe psoriasis after initiating tumor necrosis factor-alpha inhibitor therapy and the value of transitioning to an alternative biologic class for effective management.<\/jats:p>","DOI":"10.1177\/2050313x251411513","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T01:14:36Z","timestamp":1769476476000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Infliximab-induced paradoxical psoriasis successfully treated with secukinumab: A case report"],"prefix":"10.1177","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-1265-1264","authenticated-orcid":false,"given":"Bianca","family":"Te","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordanna","family":"Roesler","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"Kunimoto","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,1,26]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2016.08.012"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jid.2024.05.015"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2018.02746"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2020.12.010"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2011.05.038"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1159\/000529218"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.3390\/medicina57101004"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/1346-8138.16164"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1159\/000534703"}],"container-title":["Sage Open Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2050313X251411513","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/2050313X251411513","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2050313X251411513","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T21:16:34Z","timestamp":1769634994000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/2050313X251411513"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":9,"alternative-id":["10.1177\/2050313X251411513"],"URL":"https:\/\/doi.org\/10.1177\/2050313x251411513","relation":{},"ISSN":["2050-313X","2050-313X"],"issn-type":[{"value":"2050-313X","type":"print"},{"value":"2050-313X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"article-number":"2050313X251411513"}}