19 year old with a several month history of anti-TNF alpha induced psoriasis

    19 year old woman with a 2 year history of Crohn’s disease treated with infliximab presented with a several month history of anti-TNF alpha induced psoriasis. Thick pink plaques with fissures and scale covered her palms and soles, and well-demarcated pink plaques were scattered over her legs, arms, and torso. The patient stated that application of clobetasol ointment made the palmoplantar plaques worse. The patient denied joint pain and a family history of psoriasis. 

    The patient’s infliximab was discontinued and she was started on ustekinumab 90mg every 8 weeks after discussion with her gasteroenterologist. After 6 months on ustekinumab, patient notes excellent control of her Crohn's disease and improvement in her psoriasis, although a few lesions remained on her palms and soles.