Successful Treatment of Adalimumab-Induced Paradoxical Skin Reactions in Pustulotic Arthro-Osteitis With Guselkumab

This document discusses a case of pustulotic arthro-osteitis (PAO) and palmoplantar pustulosis (PPP) treated with adalimumab, an anti-TNF-α agent, which resulted in paradoxical skin reactions (PSRs) such as psoriasis-like rashes and acute hair loss. The treatment was switched to guselkumab, an anti-IL-23 p19 monoclonal antibody, which effectively managed both PAO/PPP and the PSRs. The document highlights that no PSRs have been reported with anti-IL-23 agents in PAO, and a study from Japan shows similar efficacy between guselkumab and adalimumab for PAO. It recommends using anti-IL-23 agents over adalimumab for PPP/PAO patients to avoid PSRs, especially since they are approved for refractory PPP in Japan.