10.5826/dpc.1202a88
text/xml
2160-9381
1980
en
Vincenzo Piccolo
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
palmoplantar
Natalizumab-Induced Pustular Psoriasis of Palms and Soles
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2022-05-02
2021-08-22
2022-05-02
2022-05-24
e2022088
Dermatol Pract Concept
Vincenzo Piccolo
2022/05/02
10.5826/dpc.1202a88
e2022088
Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
2160-9381
palmoplantar
en
e2022088
Lambrianides S, Kinnis E, Leonidou E, Pantzaris M. Does natalizumab induce or aggravate psoriasis? A case study and review of the literature. Case Rep Neurol. 201818;10(3):286-291. DOI: 10.1159/000492891. PMID: 30323758. PMCID: PMC6180259.
Natalizumab-Induced Pustular Psoriasis of Palms and Soles
https://dpcj.org/index.php/dpc/article/download/1980/1591
                 Natalizumab-Induced Pustular Psoriasis
                          of Palms and Soles
             Bengisu Ozarslan1, Teresa Russo2, Giuseppe Argenziano2, Vincenzo Piccolo2


1 Dermatology Unit, Doku Medical Center, Istanbul, Turkey
2 Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy



Key words: natalizumab, psoriasis, pustular, palmo-plantar
Citation: Ozarslan B, Russo T, Argenziano G, Piccolo V. Natalizumab-Induced Pustular Psoriasis of Palms and Soles.
Dermatol Pract Concept. 2022;12(2):e2022088. DOI: https://doi.org/10.5826/dpc.1202a88
Accepted: September 18, 2021; Published: April 2022
Copyright: ©2022 Ozarslan et al. This is an open-access article distributed under the terms of the Creative Commons
Attribution-NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted
noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding author: Vincenzo Piccolo, MD, c/o II Policlinico, building 9, first floor, via Pansini 5 - 80131 Napoli, Italy.
E-mail: piccolo.vincenzo@gmail.com




Introduction                                                              globules and crusts along with the dotted vessels (Figure 1B).
                                                                          The patient was diagnosed with pustular psoriasis of palms
Psoriasis and multiple sclerosis (MS) are both autoimmune                 and soles.
T-cell mediated diseases that share a possible common ge-
netic linkage [1]. Natalizumab is a recombinant humanized
monoclonal antibody targeting the cell adhesion molecule
                                                                          Discussion
α4 integrin and is labeled to treat MS. It is known that bi-              Data on whether natalizumab can induce or aggravate psori-
ological agents induce cutaneous adverse drug reactions.                  asis are limited. In literature, 2 of the cases developed plaque
Although there is not a defined link between natalizumab                  psoriasis while 1 patient had new-onset psoriatic arthritis
and psoriasis, there are case reports describing a possible re-           during natalizumab treatment. Family history of psoriasis
lationship [2]. Here, we report on a patient with MS who                  was positive in all patients. One patient affected by mild pso-
developed pustular psoriasis of palms and soles after natali-             riasis had a severe flare-up after several natalizumab infu-
zumab treatment.                                                          sions [2]. Our patient, on the other hand, differs from those
                                                                          cases due to the absence of family history and the develop-
Case Presentation                                                         ment of localized pustular psoriasis.
                                                                              Although there are pieces of evidence showing com-
A 50-year-old woman presented with multiple millimetric                   mon pathophysiological pathways in psoriasis and MS, it
pustules and scaling sited on erythematous plaques on the                 has been observed that treatment of one condition did not
palms and soles (Figure 1A). Personal and familiar history                ­provide a parallel improvement in the other one. T helper 17
for psoriasis was negative. She has been treated with natal-              (Th17) cells are involved in the inflammation stage of both
izumab for 6 months for MS. Dermoscopy revealed yellow                    disease [1]. The pathophysiological mechanism between



Research Letter | Dermatol Pract Concept. 2022;12(2):e2022088                                                                           1
                     Figure 1. (A) Multiple pustules and crusting over the palm. (B) Dermoscopic image demon-
                     strates yellow globules and crusts along with the dotted vessels.



psoriasis and natalizumab remains unclear but natalizumab          research is needed to understand the relationship between
has been associated with paradoxical activation of autoim-         natalizumab and psoriasis.
mune disorders by pathologically stimulating the production
of IL17 and increased activation of Th17 cells [2].
                                                                   References
Conclusions                                                         1. Kwok T, Loo WJ, Guenther L. Psoriasis and multiple sclerosis:
                                                                       is there a link? J Cutan Med Surg. 2010;14(4):151-155. DOI:
                                                                       10.2310/7750.2010.09063. PMID: 20642982.
We highlight that a new onset of palmoplantar pustular pso-
                                                                    2. Lambrianides S, Kinnis E, Leonidou E, Pantzaris M. Does na-
riasis may also be a rare side effect of natalizumab. There
                                                                       talizumab induce or aggravate psoriasis? A case study and
is not enough data yet to make a recommendation regard-                review of the literature. Case Rep Neurol. 201818;10(3):
ing the consideration of psoriasis history in the patient or in        286-291. DOI: 10.1159/000492891. PMID: 30323758. ­PMCID:
the family when deciding for natalizumab treatment. More               PMC6180259.




2                                                                      Research Letter | Dermatol Pract Concept. 2022;12(2):e2022088
