{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T15:59:01Z","timestamp":1778947141535,"version":"3.51.4"},"reference-count":10,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2019,3,26]],"date-time":"2019-03-26T00:00:00Z","timestamp":1553558400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns4:p>Psoriasis is a chronic immune-mediated inflammatory disease. Up to 40% of patients with psoriasis may develop psoriatic arthritis.\u00a0 Currently, interleukin (IL)-17\/IL-23 pathways are identified as key factors in the immunopathogenesis of both conditions. Here we describe the case of a patient who developed psoriasiform skin lesions 10 months after the initiation of anti-IL17 therapy for psoriatic arthritis. The underlying disease had responded well to the therapy, but the patient developed a striking pustular eruption at the fingers with nail involvement, onycholysis, yellow discoloration, and subungual keratosis. Clinical and histological findings were consistent with an acrodermatitis continua of Hallopeau-like eruption. Skin lesions subsided after discontinuation of the responsible anti-IL17 agent. The interpretation of this paradoxical side effect of biological therapies remains unclear but may relate to an unbalanced inflammatory cytokine response induced by the inhibition of TNF activity. It is likely that patients, who are genetically prone, may respond exaggeratedly to a cytokine imbalance. The identification of this kind of patient, in the future, could be useful in order to choose the correct therapy.<\/ns4:p>","DOI":"10.12688\/f1000research.18493.1","type":"journal-article","created":{"date-parts":[[2019,3,26]],"date-time":"2019-03-26T07:50:08Z","timestamp":1553586608000},"page":"336","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Case Report: Paradoxical acrodermatitis of Hallopeau-like eruption following anti-IL-17 therapy"],"prefix":"10.12688","volume":"8","author":[{"given":"Giulia","family":"Tadiotto Cicogna","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Messina","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda","family":"Nalotto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Serena","family":"Szekely","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6524-4848","authenticated-orcid":false,"given":"Mauro","family":"Alaibac","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2019,3,26]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"277-294","DOI":"10.1177\/1759720X17735756","article-title":"Anti-interleukin and interleukin therapies for psoriasis: current evidence and clinical usefulness.","volume":"9","author":"Y Tsai","year":"2017","journal-title":"Ther Adv Musculoskelet Dis."},{"key":"ref-2","doi-asserted-by":"publisher","first-page":"423-441","DOI":"10.1007\/s40265-014-0191-y","article-title":"Managing patients with psoriatic disease: the diagnosis and pharmacologic treatment of psoriatic arthritis in patients with psoriasis.","volume":"74","author":"P Mease","year":"2014","journal-title":"Drugs."},{"key":"ref-3","doi-asserted-by":"publisher","first-page":"359-373","DOI":"10.1007\/s40259-013-0025-6","article-title":"Therapeutic strategies in psoriasis patients with psoriatic arthritis: focus on new agents.","volume":"27","author":"E Gan","year":"2013","journal-title":"BioDrug."},{"key":"ref-4","doi-asserted-by":"publisher","first-page":"1195-1211","DOI":"10.1111\/j.1365-4632.2011.04993.x","article-title":"Acrodermatitis continua of Hallopeau: evolution of treatment options.","volume":"50","author":"V Sehgal","year":"2011","journal-title":"Int J Dermatol."},{"key":"ref-5","doi-asserted-by":"publisher","DOI":"10.3390\/ijms19010179","article-title":"Scanning the Immunopathogenesis of Psoriasis.","volume":"19","author":"A Chiricozzi","year":"2018","journal-title":"Int J Mol Sci."},{"key":"ref-6","doi-asserted-by":"publisher","first-page":"743-753","DOI":"10.1007\/s10067-013-2252-0","article-title":"Side effects of TNF-\u03b1 blockers in patients with psoriatic arthritis: evidences from literature studies.","volume":"32","author":"R Peluso","year":"2013","journal-title":"Clin Rheumatol."},{"key":"ref-7","doi-asserted-by":"publisher","first-page":"41-49","DOI":"10.2147\/DDDT.S10494","article-title":"Comparative assessment of biologics in treatment of psoriasis: drug design and clinical effectiveness of ustekinumab.","volume":"5","author":"I Garcia-Valladares","year":"2011","journal-title":"Drug Des Devel Ther."},{"key":"ref-8","doi-asserted-by":"publisher","first-page":"718-719","DOI":"10.1111\/ced.13375","article-title":"Paradoxical localized exacerbation of psoriatic eruptions triggered by secukinumab.","volume":"43","author":"D Hoshina","year":"2018","journal-title":"Clin Exp Dermatol."},{"key":"ref-9","doi-asserted-by":"publisher","first-page":"212-214","DOI":"10.3109\/09546634.2010.534430","article-title":"Flare of pustular psoriasis after initiating ustekinumab therapy.","volume":"23","author":"K Wenk","year":"2012","journal-title":"J Dermatolog Treat."},{"key":"ref-10","doi-asserted-by":"publisher","first-page":"49-63","DOI":"10.1159\/000479475","article-title":"Paradoxical Reactions: Anti-Tumor Necrosis Factor Alpha Agents, Ustekinumab, Secukinumab, Ixekizumab, and Others.","volume":"53","author":"L Puig","year":"2018","journal-title":"Curr Probl Dermatol."}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/8-336\/v1\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/8-336\/v1\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/8-336\/v1\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,3,9]],"date-time":"2020-03-09T05:35:09Z","timestamp":1583732109000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/8-336\/v1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,3,26]]},"references-count":10,"URL":"https:\/\/doi.org\/10.12688\/f1000research.18493.1","relation":{"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.20235.r51595","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.20235.r48170","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.20235.r51595","asserted-by":"object"},{"id-type":"doi","id":"10.5256\/f1000research.20235.r48170","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,3,26]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/8-336\/v1#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.20235.r48170, Archana Gopalakrishnan, University of Maryland, Baltimore, Baltimore, MD, USA, 15 May 2019, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/8-336\/v1#referee-response-48170","order":0,"name":"referee-response-48170","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Mauro Alaibac<\/b>; \n<i>Posted: 07 Mar 2020<\/i>; Dear Reviewer,Thank you&nbsp; for the very careful review of our paper.&nbsp;Please find below a point by point response to your constructive comments&nbsp;  Would decreasing the dosage of the drug (from 150mg every 4 weeks)&nbsp;been able to reduce the ACH like eruption along with treating PsA? It would be useful if the authors could reference successful cases, if any documented, where the drug has been functional at lower doses.&nbsp; &nbsp;  &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;We are not able to confirm if a reduced dosage is&nbsp;more effective in suppressing&nbsp;the ACH like eruption than the discontinuation of the treatment as there are no documented cases appeared in the literature concerning this issue.&nbsp; &nbsp; &nbsp; &nbsp; &nbsp;2. A cytokine imbalance leading to an increase in TNF during secukinumab treatment has been suggested - is there corroborating evidence that implies this? If blood samples from the patient&nbsp;has been saved, can systemic levels of TNF be assayed for?&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; We have not saved a blood sample from the patient, but evaluation of&nbsp;systemic levels of TNF- alpha in patients under treatment with secukinumab could be an interesting investigation which&nbsp;could corroborate our hypothesis.&nbsp; &nbsp; &nbsp; &nbsp; 3&nbsp; The authors raised an excellent point about underlying genetics contributing to the potential&nbsp; cytokine imbalance. This might be a very crucial finding and if so, could the authors highlight the&nbsp;nature of the polymorphisms to look for in future cases?&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; There is a large&nbsp;heterogeneity of inflammatory networks driving psoriasis and this make difficult to identify a specific polymorphism which could be responsible for the potential cytokine imbalance.","URL":"https:\/\/f1000research.com\/articles\/8-336\/v1#referee-comment-5286","order":1,"name":"referee-comment-5286","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.20235.r51595, Melinda J. Gooderham, SKiN Centre for Dermatology, Peterborough, ON, Canada, 05 Aug 2019, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/8-336\/v1#referee-response-51595","order":2,"name":"referee-response-51595","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Mauro Alaibac<\/b>; \n<i>Posted: 07 Mar 2020<\/i>; Dear Reviewer,Thank for your thoughtful and constructive comments. We do agree with you that similarly to TNF-alpha, IL-17 may show unexpected &quot;paradoxical&quot; eruptions and further experimental and clinical observations are necessary to determine the underlying pathophysiology driving this reaction.","URL":"https:\/\/f1000research.com\/articles\/8-336\/v1#referee-comment-5287","order":3,"name":"referee-comment-5287","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":4,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}