{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T06:17:54Z","timestamp":1788675474917,"version":"build-2803163510"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>\n                    Patients treated with TNF-\u03b1 antagonists may develop psoriasis-like skin lesions. Clinical manifestations include palmoplantar, inverse, localized or generalized guttate, plaque-type, eczematous, and pustular lesions; deep inflammatory nodes; and nonscarring alopecia, often with overlapping reaction patterns. They are classified as paradoxical psoriasis and interpreted as an inflammatory reaction resulting from the disturbed maturation of plasmacytoid dendritic cells, with overproduction of type I interferons due to tumor necrosis factor \u03b1 (TNF-\u03b1) inhibition. Management frequently necessitates discontinuation of therapy. Here, we review the clinical presentation of six patients who were initially diagnosed with paradoxical psoriasis during TNF-\u03b1 blockade due to the development of corresponding skin lesions. Dermatologic examination revealed that the lesions were impetigo contagiosa, ecthyma, folliculitis decalvans, ostiofolliculitis, nummular microbial eczema, or abscessing furunculosis\u2014all caused by\n                    <jats:italic>Staphylococcus aureus<\/jats:italic>\n                    , likely spreading from the colonized nasal mucosa to the skin. The cutaneous symptoms resolved with topical antimicrobial therapy and systemic antibiotic treatment. We conclude that many cases diagnosed as paradoxical psoriasis may, in fact, represent generalized abscessing staphyloderma resulting from impaired antimicrobial immunity under TNF-\u03b1 blockade. The diagnosis of paradoxical psoriasis should therefore be critically re-evaluated on a case-by-case basis. Identification and eradication of\n                    <jats:italic>S. aureus<\/jats:italic>\n                    may substantially improve the prognosis for patients experiencing paradoxical psoriasis-like manifestations during treatment with TNF-\u03b1 antagonists.\n                  <\/jats:p>","DOI":"10.3389\/fimmu.2026.1726457","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T05:43:34Z","timestamp":1780983814000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Paradoxical psoriasis under TNF-\u03b1 blockade may represent generalized abscessing staphyloderma \u2013 GASD syndrome by TNF antagonists"],"prefix":"10.3389","volume":"17","author":[{"given":"J\u00f6rg C.","family":"Prinz","sequence":"first","affiliation":[{"name":"Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian-University of Munich","place":["Munich, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pia-Charlotte","family":"Stadler","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian-University of Munich","place":["Munich, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1084\/jem.20240806","article-title":"Targeting Tnf\/Tnfr superfamilies in immune-mediated inflammatory diseases","volume":"221","author":"Veerasubramanian","year":"2024","journal-title":"J Exp Med"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.2165\/00002018-200427050-00003","article-title":"Safety of tumour necrosis factor-alpha antagonists","volume":"27","author":"Khanna","year":"2004","journal-title":"Drug Saf"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61704-9","article-title":"Risk of serious infection in biological treatment of patients with rheumatoid arthritis: A systematic review and meta-analysis","volume":"386","author":"Singh","year":"2015","journal-title":"Lancet"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(21)00312-5","article-title":"Comparative efficacy and safety of biologic therapies for moderate-to-severe Crohn\u2019s disease: A systematic review and network meta-analysis","volume":"6","author":"Singh","year":"2021","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1517\/14740338.2015.1009036","article-title":"Infection risk associated with anti-Tnf-alpha agents: A review","volume":"14","author":"Murdaca","year":"2015","journal-title":"Expert Opin Drug Saf"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3109\/08923973.2011.653646","article-title":"Safety of anti-Tnfalpha agents in the treatment of psoriasis and psoriatic arthritis","volume":"34","author":"Girolomoni","year":"2012","journal-title":"Immunopharmacol Immunotoxicol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2010.04.003","article-title":"Psoriatic skin lesions induced by tumor necrosis factor antagonist therapy: Clinical features and possible immunopathogenesis","volume":"40","author":"Collamer","year":"2010","journal-title":"Semin Arthritis Rheum"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1097\/DAD.0b013e3181cb3ff7","article-title":"Histopathologic spectrum of psoriasiform skin reactions associated with tumor necrosis factor-alpha inhibitor therapy. 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