Background Pustulotic arthro‐osteitis (PAO) is a major comorbidity of palmoplantar pustulosis (PPP), which is frequently seen in Japanese patients. To determine the characteristics of Japanese patients with PAO, we conducted a multicenter, retrospective epidemiologic survey at four university hospitals. Methods Clinical features including age, gender, duration of disease, extrapalmoplantar lesion, smoking habit, focal infection, site of joint pain, bone scintigraphy with Technetium99, and therapies were retrospectively evaluated. Results In total, 165 patients with PAO were identified among 576 patients with PPP (28.6%). The male to female ratio was 1 : 3.7, and the mean age was 50.2 years. The mean disease duration of PAO was 6.0 years. Smoking habit was observed in 104 patients. Focal infection was detected in 74 patients, who developed tonsillar infection (n = 41), sinusitis (8), odontogenic infection (40), and others (2). Fifteen patients had multifocal infection. Technetium bone scintigraphy was performed in 97 cases. Increased uptake was most frequently observed in the sternocostoclavicular regions, followed by wrist and ankle, sacroiliac joint, knee and elbow, finger and toe, lumbar spine, thoracic spine, scapula, and thigh. Patients were mainly treated with nonsteroidal anti‐inflammatory drugs, methotrexate, cyclosporine, antibiotics, and biologics, as well as tonsillectomy and dental treatment. Conclusion PAO frequently involves the anterior chest wall of middle‐aged women with smoking habit and is closely associated with focal infection.

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Summary Background With the increasing use of biological agents for the treatment of psoriasis, the numbers of patients with interstitial lung disease (ILD) associated with biologics have also increased. Many of these cases were associated with tumour necrosis factor (TNF)‐α inhibitors, but cases associated with other families of biologics have also been reported in Japan. Aim To analyse the background factors of patients who developed ILD, and to discuss better management of biological treatment. Method We reviewed 246 patients with psoriasis who were treated with biological agents in our department to identify any pulmonary adverse events (AEs). Data on patients who developed ILD were extracted to analyse background factors, clinical type of psoriasis, time to onset of ILD, pre‐existing ILD, smoking habit and prescribed drugs. Results Pulmonary AEs were seen in 22 cases, of which 11 were diagnosed as drug‐induced ILD. The causative drugs were mainly TNF‐α inhibitors, accounting for eight cases (six treated with infliximab, two with adalimumab). The remaining three cases were associated with secukinumab, ustekinumab and ixekizumab (n = 1 each). Notably, these three cases also had a history of drug‐induced ILD. Conclusion Patients with a history of drug‐induced ILD seem to be more susceptible to developing another ILD induced by biologics, even if treated with interleukin‐17 inhibitors. Thorough screening of risk factors and evaluation for eligibility, and careful monitoring during treatment are the best solutions to avoid serious pulmonary AE. Early detection and precise diagnosis of pulmonary AEs, especially differentiation from infectious diseases, is essential for managing biological treatment.

A 60-year-old Japanese woman presented with a 2-week history of facial erythema. Clinical examination revealed oedematous erythema accompanied by pruritus on the face, mostly on the cheek and forehead (Fig. 1a, b). No leukoderma was observed. Contact dermatitis caused by an allergic response to a cosmetic cream was suspected. Repeated open application tests resulted in erythema on the next day (Fig. 1c). Patch tests were conducted with Finn Chambers ® on Scanpor ® tape on the patient's back and upper arm, and the reactions were read on day (D)