The anti-TNF paradox: palmoplantar pustular psoriasis.

Paradoxical psoriasis induced by anti-TNF therapy is an infrequent reaction in patients with inflammatory bowel disease, characterized by the appearance of cutaneous lesions during biologic treatment, despite these agents also being used to manage psoriasis. It can present in vulgar, pustular, or palmoplantar forms and typically occurs within the first year of therapy. Early recognition is crucial to guide clinical management and consider therapeutic strategies targeting alternative immunological pathways, as illustrated in the case described.