PMC9815903_01
Multiple disseminated sterile pin-head pustules on the erythematic background are spreading on the neck(A), abdomen(C), upper(B), and lower extremities(D). Desquamation of the pustules and the erythematic rash began to fade on the neck(E), back trunk(F), upper(G), and lower extremities(H) three days after Adalimumab treatment. Clearance of lesions on the neck(I), back trunk(J), upper (K), and lower(L) extremities after discounting the terbinafine and treatment with Adalimumab.
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On dermatological examination, prominent edematous erythema on the trunk and extremities with dense superficial partially fused sterile non-follicular pin-head size to rice-grain pustules and target lesions was seen the Nikolsky's sign was negative (Figure 1A-D). On the 3rd day of the adalimumab regimen, erythema and erythematic rash on the neck and trunk began to fade, some pustules dried up, and scaly skin gradually faded (Figure 1E-H). The patient was discharged from the hospital; no recurrences were noted at the outpatient follow-up 14 days after discharge (Figure 1I-L).
Epidermal hyperkeratosis and parakeratosis, neutrophil infiltration in the stratum corneum, abscess formation, irregular thickening of the spinous layer, spongiosis, and liquefaction degeneration in the basal layer. The epithelium extends inferiorly and is serrated. Lymphocytes infiltrate in the superficial dermis and around the skin adnexa (a, b) (magnification x 400).
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The histopathological picture showed epidermal hyperkeratosis, parakeratosis, multiple abscess formation in the stratum corneum, spongiosis, and perivascular inflammatory cells containing lymphocytes, eosinophils, and neutrophils in the superficial dermis (Figure 2).