Resolution of adalimumab-induced psoriasis after vitamin D deficiency treatment

Tumoral necrosis factor alpha blockers are very efficient in the treatment of many inflammatory systemic diseases, including rheumatoid arthritis and psoriasis. However, a paradoxical arouse of psoriasiform lesions may occur in a few patients taking anti-TNF alpha. The etiology of this rare side effect is still a mystery, and its treatment may be difficult. The authors report the resolution of adalimumab-induced psoriasis in a woman with rheumatoid arthritis after the use of high vitamin D-3 doses for the treatment of vitamin D deficiency. This is the first report of resolution of anti-TNF alpha-induced psoriasiform lesions by high doses of vitamin D-3 in a patient with rheumatoid arthritis and vitamin D deficiency. This case raises interesting questions on the role of vitamin D deficiency in the pathogenesis of this side effect and on the possible usefulness of high-dose vitamin D-3 in its treatment.