We read with interest the article by Voigtländer et al¹ concerning the efficacy of infliximab therapy for Sneddon-Wilkinson disease, as well as the more recent report by O'Quinn and Miller² of 2 cases of recalcitrant psoriasis that responded well to infliximab therapy. We would like to report our experience with infliximab-methotrexate combination therapy for severe pustular psoriasis of the palms and soles.

A 70-year-old man presented with recalcitrant pustular psoriasis of the palms and soles that responded dramatically to monthly infusions of infliximab (Remicade; Centocor Inc, Malvern, Pa) at a dosage of 5 mg/kg but relapsed after 5 courses. The dosage was increased to 10 mg/kg, with an initial clearing of the lesions; however, after the second infusion, he again developed pustules. The addition of methotrexate sodium (7.5 mg/wk) to his regimen resulted in a complete response, with a lasting remission.