Subcorneal pustular dermatosis triggered by adalimumab in a patient with ankylosing spondylitis and Crohn’s disease

Tumor necrosis factor-alpha (TNF-α) inhibitors, notably adalimumab, represent a cornerstone in managing chronic inflammatory disorders such as ankylosing spondylitis and Crohn's disease. Despite their therapeutic efficacy, paradoxical dermatologic adverse events, including pustular eruptions, have been occasionally documented. This report presents the case of a 62-year-old Caucasian female patient who developed erythematous-pustular lesions following prolonged exposure to adalimumab. Histopathologic assessment confirmed subcorneal pustular dermatosis (SPD), characterized by subcorneal neutrophilic accumulations and focal spongiosis. Discontinuation of adalimumab and initiation of systemic corticosteroids alone led to prompt clinical resolution. This case contributes to the limited literature on anti-TNF-induced SPD, emphasizing the critical role of early recognition and interdisciplinary intervention.