Document Type : Case Report


1 Department of Dermatology, Shiraz University of Medical Sciences, Shiraz, Iran

2 Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

3 Shahid Faghihi Hospital, Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran


Sneddon-Wilkinson disease, also known as subcorneal pustular
dermatosis (SPD), is a relapsing pustular dermatosis of unknown
etiology. The vesiculopustules typically present on the trunk
and intertriginous areas. The mainstay of SPD treatment is
dapsone; second-line therapies include corticosteroids and other
immunosuppressive drugs. Here, we report a case of recalcitrant
severe SPD that responded dramatically to adalimumab. The
patient was a 30-year-old man who presented with generalized
erythroderma and vesiculopustules on the trunk and extremities.
In some pustules, the pus settled with gravity into the lower
half of the blister. He responded dramatically to a combination
of adalimumab (80 mg on day 1, 40 mg on day 7, and 40 mg
biweekly afterward) and prednisolone 50 mg daily. During followup,
prednisolone was tapered to 5 mg daily over 2 months, and
adalimumab was maintained biweekly; he is still in remission
after 8 months. Thus, adalimumab can be used as an effective
and easy-to-use treatment in refractory cases of SPD.