Acute Self-Harm Ideation as Presenting Adverse Event Associated with Adalimumab Treatment of Severe Scalp Psoriasis

We report a 34-year-old woman with severe scalp psoriasis presented to a dermatology clinic in San Diego, USA, in 2023. She developed acute self-harm ideations and major depressive symptoms shortly after initiating adalimumab treatment. The patient had a history of major depressive disorder, post-traumatic stress disorder and anxiety, all well-controlled with multiple medications. Following the administration of adalimumab, she experienced intrusive thoughts of self-harm and exacerbation of depressive symptoms, prompting immediate discontinuation of the drug. The patient's symptoms resolved completely 3 weeks after discontinuation. This case highlights the potential psychiatric risks associated with adalimumab therapy for psoriasis, especially in patients with pre-existing mental health conditions. Dermatologists should carefully evaluate patients for psychiatric disorders and suicide risk factors before initiating treatment and be vigilant in monitoring for adverse psychiatric events during therapy. Proper counselling and prompt identification of adverse events are crucial to prevent serious outcomes.