Fig. 1.

Clinical appearance just before the treatment with ustekinumab and methotrexate. a The patient manifested with scaly well-circumscribed erythemas (2–5 cm in diameter) on his trunk and extremities. The psoriasis area severity index was 5.0. b All nails of the hands and feet of the patient were thickened, deformed, and coarse. He also manifested with swelling and pain in multiple small and large joints including the proximal interphalangeal joints of his right fourth finger, right third toe, and left second toe, and pain in multiple interphalangeal joints of his feet, bilateral hip joints, and bilateral ankle.