Infliximab (anti-tumor necrosis factor alpha antibody): a novel, highly effective treatment of recalcitrant subcorneal pustular dermatosis (Sneddon-Wilkinson disease).

A 79-year old woman presented with a 7-year history of subcorneal pustular dermatosis (SPD). Primary lesions presented as widespread symmetrical eruptions with erythema and flaccid pustules of up to 5 mm in diameter (Figure 1A). Diagnosis was based on the clinical symptoms and the characteristic histologic finding of subcorneal sterile pustules in several skin biopsy specimens (Figure 2A). The results of indirect and direct immunofluorescence analyses were negative (not shown). The clinical course was resistant to multiple therapeutic trials including colchicine, retinoids, systemic glucocorticosteroids, UV phototherapy, azathioprine, and azulfidine. Dapsone treatment had to be discontinued because the patient developed hemolytic anemia. A year prior to presenting to our department, the patient was diagnosed with breast cancer and underwent ablative surgery with dissection of the regional axillary lymph nodes. At the time of admission to our department for treat-