Certolizumab-induced lichenoid eruption in a patient with rheumatoid arthritis

BMJ Case Rep. 2021 Dec 9;14(12):e245875. doi: 10.1136/bcr-2021-245875.


Certolizumab is a monoclonal antibody against tumour necrosis factor-alpha (TNF-α) commonly used in rheumatologic conditions such as rheumatoid arthritis. Skin rashes are an uncommon side effect with few cases of lichenoid drug eruption reported in the literature. We describe a patient with rheumatoid arthritis who presented 6 weeks after initiating certolizumab pegol. Physical examination showed pink-to-violaceous papules on her upper and lower extremities. Biopsy confirmed a lichenoid drug eruption. The medication was discontinued and she was treated with topical steroids and a calcineurin inhibitor, with resolution of her lesions. Clinicians should be cognizant of such adverse reactions to TNF-α inhibitors and keep drug-induced lichenoid eruptions on the differential. Lichenoid eruptions induced by certolizumab pegol may affect the skin and/or mucous membranes. While most cases occur within weeks to months of starting therapy, eruptions may occur years after treatment initiation, underscoring the importance of a thorough review of medications.

Keywords: dermatology; drug interactions; immunology; rheumatoid arthritis.

Publication types

  • Case Reports

MeSH terms

  • Antibodies, Monoclonal
  • Arthritis, Rheumatoid* / drug therapy
  • Certolizumab Pegol / adverse effects
  • Drug Eruptions* / etiology
  • Female
  • Humans
  • Lichenoid Eruptions* / chemically induced


  • Antibodies, Monoclonal
  • Certolizumab Pegol