Papulosquamous disorders: paradoxical psoriasis with anti-TNF: practice question

A Dermatology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Dermatology · Papulosquamous disorders: paradoxical psoriasis with anti-TNF

Sample item

A patient with Crohn disease on infliximab develops new palmoplantar pustular psoriasis. What is this phenomenon called and how is it managed?

ADermatophyte infectionBDisease relapse that needs higher infliximab doses alwaysCA drug allergy that requires adrenalineDParadoxical psoriasis, managed by topical therapy or switching biologic class

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Paradoxical psoriasis, managed by topical therapy or switching biologic class

Anti-TNF agents can paradoxically induce psoriasis, particularly palmoplantar pustular forms, in patients treated for other diseases. Management ranges from topical therapy to switching to another TNF inhibitor or a different class such as an IL-17 or IL-23 blocker. Infection should be excluded.

Option by option

A. Dermatophyte infection
It is sterile and not a fungal infection.
B. Disease relapse that needs higher infliximab doses always
It is a new phenomenon and not simply a relapse.
C. A drug allergy that requires adrenaline
It is not an IgE-mediated allergic reaction.
D. Paradoxical psoriasis, managed by topical therapy or switching biologic class (correct)
Correct. This is paradoxical psoriasis from anti-TNF therapy.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Dermatology question

What is the answer to this Dermatology question?

The best answer is D, Paradoxical psoriasis, managed by topical therapy or switching biologic class. Anti-TNF agents can paradoxically induce psoriasis, particularly palmoplantar pustular forms, in patients treated for other diseases.

Why is "Dermatophyte infection" not the answer?

It is sterile and not a fungal infection.

Why is "Disease relapse that needs higher infliximab doses always" not the answer?

It is a new phenomenon and not simply a relapse.

Why is "A drug allergy that requires adrenaline" not the answer?

It is not an IgE-mediated allergic reaction.

What concept does this question test?

It tests Papulosquamous disorders: paradoxical psoriasis with anti-TNF in Dermatology. Management ranges from topical therapy to switching to another TNF inhibitor or a different class such as an IL-17 or IL-23 blocker. Infection should be excluded.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Papulosquamous disorders: paradoxical psoriasis with anti-TNF?

Learn each condition by its primary lesion, site and signature sign. Then use the flashcards and the other Dermatology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.