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Efficacy and safety of adalimumab in difficult‐to‐treat psoriasis

Psoriasis is a chronic immune‐mediated inflammatory skin disorder, with a prevalence of 2% to 3% worldwide. Psoriatic lesions affecting scalp, nails, palms, and soles are considered difficult‐to‐treat and require specific management. When psoriasis involves these areas, it may be considered more severe even if the lesions are not extensive. Adalimumab (Humira) is a fully human monoclonal antibody against tumor necrosis factor (TNF), administered via subcutaneous injection. It has already been used in the treatment of adults and children with moderate‐to‐severe chronic plaque psoriasis. In literature, few studies investigated its efficacy in difficult‐to‐treat areas, hence we conducted an observational prospective study of 24 weeks to assess its role in patients with difficult to treat psoriasis. We found out a significant improvement in nail and scalp psoriasis, while palmoplantar and genital psoriasis showed an improvement though not statistically significant. Therefore, adalimumab can be used in difficult‐to‐treat areas with great results, also allowing an improvement in the quality of life of affected patients, both adults and children.