PMC9128051_01
Cutaneous manifestations observed at the patient's initial evaluation. Note the scaling palmar and plantar rash with the extensor surface of the arms involved bilaterally.
10.1177_20406223221099333-fig1.jpg
PMC9128051_01_10.1177_20406223221099333-fig1.jpg
fig1-20406223221099333
A 51-year-old man presented to the emergency department complaining of fatigue, new onset of rash with desquamation, and generalized arthralgia (Figure 1).
Cutaneous manifestations observed at the patient's initial evaluation with rheumatology. Note the silvery scaling lesions affecting the extensor surfaces of the arms with oncholytic nail changes as well.
10.1177_20406223221099333-fig2.jpg
PMC9128051_01_10.1177_20406223221099333-fig2.jpg
fig2-20406223221099333
One month later that patient had completed his steroid taper, dyspnea had resolved, but persistent desquamative rash and synovitis involving the proximal interphalangeal joints and right wrist prompted further treatment (Figure 2).
Left forearm skin. Hematoxylin & Eosin stain, 200x magnification. The stratum corneum in this area (black arrow) of the left arm biopsy shows a collection of pyknotic nuclei being expelled upward from the granular layer indicating a chronic, recurrent inflammatory process. The enlarged insert to demonstrate the presence of eosinophils.
10.1177_20406223221099333-fig3.jpg
PMC9128051_01_10.1177_20406223221099333-fig3.jpg
fig3-20406223221099333
His rash was biopsied from multiple sites and histopathology indicated a spongiotic/psoriasiform dermatitis (Figures 3 and 4).
Left calf. Hematoxylin & Eosin stain, 200x magnification. The superficial dermal capillaries of the left calf skin shave are prominent and surrounded by scant, scattered lymphocytes. This area shows extravasated red blood cells (RBCs) (square).
10.1177_20406223221099333-fig4.jpg
PMC9128051_01_10.1177_20406223221099333-fig4.jpg
fig4-20406223221099333
His rash was biopsied from multiple sites and histopathology indicated a spongiotic/psoriasiform dermatitis (Figures 3 and 4).
Near complete resolution of the previously noted cutaneous manifestations 6 weeks after starting adalimumab.
10.1177_20406223221099333-fig5.jpg
PMC9128051_01_10.1177_20406223221099333-fig5.jpg
fig5-20406223221099333
Just 6 weeks after starting therapy, the patient experienced a significant improvement in his symptoms and rash (Figure 5).