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Certolizumab-induced lichenoid eruption in a patient with rheumatoid arthritis
  1. Anuj Kunadia1,
  2. Kenneth Shulman2 and
  3. Naveed Sami3
  1. 1College of Medicine, University of Central Florida, Orlando, Florida, USA
  2. 2Dermatology, New York Medical College, Valhalla, New York, USA
  3. 3Dermatology, University of Central Florida, Orlando, Florida, USA
  1. Correspondence to Dr Naveed Sami; nsderm{at}


Certolizumab is a monoclonal antibody against tumour necrosis factor-alpha (TNF-α) commonly used in rheumatologic conditions such as rheumatoid arthritis. Skin rashes are an uncommon side effect with few cases of lichenoid drug eruption reported in the literature. We describe a patient with rheumatoid arthritis who presented 6 weeks after initiating certolizumab pegol. Physical examination showed pink-to-violaceous papules on her upper and lower extremities. Biopsy confirmed a lichenoid drug eruption. The medication was discontinued and she was treated with topical steroids and a calcineurin inhibitor, with resolution of her lesions. Clinicians should be cognizant of such adverse reactions to TNF-α inhibitors and keep drug-induced lichenoid eruptions on the differential. Lichenoid eruptions induced by certolizumab pegol may affect the skin and/or mucous membranes. While most cases occur within weeks to months of starting therapy, eruptions may occur years after treatment initiation, underscoring the importance of a thorough review of medications.

  • dermatology
  • drug interactions
  • immunology
  • rheumatoid arthritis

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  • Contributors AK wrote the manuscript, performed analysis and conducted a review of the literature with support from NS and KS. KS made significant contributions to the acquisition and analysis of the data. NS conceived and supervised the project and made significant contributions to the analysis and validation of the data.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.