{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T15:07:03Z","timestamp":1773673623971,"version":"3.50.1"},"reference-count":14,"publisher":"PAGEPress Publications","issue":"1","license":[{"start":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T00:00:00Z","timestamp":1748563200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dermatol Reports"],"abstract":"<jats:p>Paradoxical psoriasis is a rare but increasingly recognized adverse effect of anti-tumor necrosis factor-\u03b1 (TNF-\u03b1) therapy, characterized by the onset or exacerbation of psoriatic lesions in patients treated for other immune-mediated conditions. We report the case of a 47-year-old woman with chronic plaque psoriasis who developed severe generalized pustular psoriasis (GPP) after six months of treatment with an adalimumab biosimilar. Given the extent and severity of the eruption and following inadequate response to previous conventional therapies, the patient was treated with brodalumab, an interleukin-17 receptor A (IL-17RA) inhibitor. Rapid and complete remission of both pustular and plaque psoriasis was achieved and maintained for over 60 weeks. This case supports the efficacy of IL-17 pathway blockade in managing paradoxical GPP and highlights the importance of prompt recognition and appropriate therapeutic switching in severe biologic-induced psoriasis.<\/jats:p>","DOI":"10.4081\/dr.2025.10414","type":"journal-article","created":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T11:19:51Z","timestamp":1748603991000},"source":"Crossref","is-referenced-by-count":0,"title":["Severe paradoxical generalized pustular psoriasis induced by adalimumab biosimilar successfully treated with brodalumab"],"prefix":"10.4081","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6352-4831","authenticated-orcid":false,"given":"Angela","family":"Fico","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3763-6922","authenticated-orcid":false,"given":"Edoardo","family":"Mortato","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8623-777X","authenticated-orcid":false,"given":"Claudia","family":"Paganini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3070-4071","authenticated-orcid":false,"given":"Marina","family":"Talamonti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4691-9381","authenticated-orcid":false,"given":"Cosimo","family":"Di Raimondo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0866-914X","authenticated-orcid":false,"given":"Dionisio","family":"Silvaggio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luca","family":"Bianchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3424-5175","authenticated-orcid":false,"given":"Marco","family":"Galluzzo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2549","published-online":{"date-parts":[[2025,5,30]]},"reference":[{"key":"36540","doi-asserted-by":"crossref","unstructured":"1. Zheng J, Gao Y, Ding Y. Successful management of infliximab-induced generalized pustular psoriasis without therapy discontinuation in a patient with psoriatic arthritis. Dermatol Ther 2019;32:e13132.","DOI":"10.1111\/dth.13132"},{"key":"36541","doi-asserted-by":"crossref","unstructured":"2. Bucalo A, Rega F, Zangrilli A, et al. Paradoxical Psoriasis Induced by Anti-TNF\u03b1 Treatment: Evaluation of Disease-Specific Clinical and Genetic Markers. Int J Mol Sci 2020;21:7873.","DOI":"10.3390\/ijms21217873"},{"key":"36542","doi-asserted-by":"crossref","unstructured":"3. Cullen G, Kroshinsky D, Cheifetz AS, Korzenik JR. Psoriasis associated with anti-tumour necrosis factor therapy in inflammatory bowel disease: a new series and a review of 120 cases from the literature. Aliment Pharmacol Ther 2011;34:1318-27.","DOI":"10.1111\/j.1365-2036.2011.04866.x"},{"key":"36543","doi-asserted-by":"crossref","unstructured":"4. Brown G, Wang E, Leon A, et al. Tumor necrosis factor-\u03b1 inhibitor-induced psoriasis: Systematic review of clinical features, histopathological findings, and management experience. J Am Acad Dermatol 2017;76:334-41","DOI":"10.1016\/j.jaad.2016.08.012"},{"key":"36544","doi-asserted-by":"crossref","unstructured":"5. Ma HL, Napierata L, Stedman N, et al. Tumor necrosis factor alpha blockade exacerbates murine psoriasis-like disease by enhancing Th17 function and decreasing expansion of Treg cells. Arthritis Rheum 2010;62:430-40.","DOI":"10.1002\/art.27203"},{"key":"36545","doi-asserted-by":"crossref","unstructured":"6. G\u00f6ssinger E, Dodiuk-Gad R, Mu\u0308hleisen B, et al. Generalized Pustular Psoriasis, Acute Generalized Exanthematous Pustulosis, and Other Pustular Reactions: A Clinical Review. Dermatol Clin 2024;42:317-28.","DOI":"10.1016\/j.det.2024.01.001"},{"key":"36546","doi-asserted-by":"crossref","unstructured":"7. Uppala R, Tsoi LC, Harms PW, et al. \u201cAutoinflammatory Psoriasis\u201d - Genetics and Biology of Pustular Psoriasis. Cell Mol Immunol 2021;18:307-17.","DOI":"10.1038\/s41423-020-0519-3"},{"key":"36547","doi-asserted-by":"crossref","unstructured":"8. Krueger J, Puig L, Tha\u00e7i D. Treatment Options and Goals for Patients with Generalized Pustular Psoriasis. Am J Clin Dermatol 2022;23:51-64.","DOI":"10.1007\/s40257-021-00658-9"},{"key":"36548","doi-asserted-by":"crossref","unstructured":"9. Rosi E, Fastame MT, Di Cesare A, et al. Targeting IL-17A for the treatment of pustular psoriasis: a comprehensive review. Expert Opin Biol Ther 2022;22:1475-87.","DOI":"10.1080\/14712598.2022.2116978"},{"key":"36549","doi-asserted-by":"crossref","unstructured":"10. Gisondi P, Girolomoni G. Brodalumab in the treatment of chronic plaque psoriasis. Expert Opin Biol Ther 2020;20:1175-86.","DOI":"10.1080\/14712598.2020.1776256"},{"key":"36550","doi-asserted-by":"crossref","unstructured":"11. Almutairi D, Sheasgreen C, Weizman A, Alavi A. Generalized Pustular Psoriasis Induced by Infliximab in a Patient With Inflammatory Bowel Disease. J Cutan Med Surg 2018;22:507-10.","DOI":"10.1177\/1203475418758986"},{"key":"36551","doi-asserted-by":"crossref","unstructured":"12. Yamasaki K, Nakagawa H, Kubo Y, et al. Efficacy and safety of brodalumab in patients with generalized pustular psoriasis and psoriatic erythroderma: results from a 52-week, open-label study. Br J Dermatol 2017;176:741-51.","DOI":"10.1111\/bjd.14702"},{"key":"36552","doi-asserted-by":"crossref","unstructured":"13. Avallone G, Maronese CA, Murgia G, et al. Interleukin-17 vs. Interleukin-23 Inhibitors in Pustular and Erythrodermic Psoriasis: A Retrospective, Multicentre Cohort Study. J Clin Med 2023;12:1662.","DOI":"10.3390\/jcm12041662"},{"key":"36553","doi-asserted-by":"crossref","unstructured":"14. Cortonesi G, Trovato E, Orsini C, et al. Paradoxical psoriasis induced by anti-TNF-alpha successfully treated with brodalumab. 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