“…Similar to our experience with our patient, almost all the antipsoriatic agents have been used in the treatment of ACH, and current literature shows <50 cases that were treated with anti-TNF-a agents (Adışen et al, 2007;Di Costanzo et al, 2014;Dini, Barbanera, & Romanelli, 2013;Lutz & Lipsker, 2012;Puig et al, 2010;Rubio, Martin, Arranz S anchez, Vidaurrazaga, & Casado, 2009;Ryan et al, 2009;Saunier et al, 2015;Sehgal et al, 2011;Thielen, Barde, Marazza, & Saurat, 2008;Tobin & Kirby, 2005). Numerous cases of ACH, but not all (Adışen et al, 2007;Lutz & Lipsker, 2012), have been reported to respond to etanercept, to infliximab, or to adalimumab, either in combination with acitretin FIG URE 1 Initial use ustekinumab; Hyperkeratotic erythematous plaques with pustules on the dorsal and ventral aspects of all fingers (a, b), an excellent response was observed after three doses of ustekinumab treatment (c, d) or monotherapy (Di Costanzo et al, 2014;Dini et al, 2013;Lutz & Lipsker, 2012;Puig et al, 2010;Rubio et al, 2009;Ryan et al, 2009;Saunier et al, 2015;Sehgal et al, 2011;Thielen et al, 2008;Tobin & Kirby, 2005). In accordance with the concept that failure of response to one anti-TNF-a antagonist does not preclude the use of another anti-TNF-a agent, cases resistant to infliximab responded to adalimumab (Tobin & Kirby, 2005) or resistant to etanercept responded to adalimumab (Dini et al, 2013;Ryan et al, 2009) or to infliximab (Thielen et al, 2008).…”