TNF and inflammatory response: Pigmented purpuric dermatoses (PPD) are chronic skin diseases with recurrent lesions and similar histopathological features, including perivascular lymphocytic inflammation, epidermal changes, and erythrocyte extravasation.1 Tumor necrosis factor-alpha (TNF-α) inhibitors are widely used in rheumatological disease management and have been associated with several skin reactions; however, reports of PPD are rare.2 This article presents a case of PPD triggered by TNF-α inhibitor therapy.