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Yang C, Wang Y, Li R, Tu P, Wang R. Successful treatment of recalcitrant generalized pustular psoriasis of pregnancy with spesolimab. J DERMATOL TREAT 2024; 35:2334791. [PMID: 38565205 DOI: 10.1080/09546634.2024.2334791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
Generalized pustular psoriasis (GPP) in pregnancy can lead to severe complications for both mother and fetus. The treatment of this disease is challenging, especially in recalcitrant and severe cases. Until present, there are no evidence-based guidelines for the treatment of GPP in pregnancy. Spesolimab, a human monoclonal antibody against the IL-36 receptor, has recently attracted attention as a new therapy for GPP flare. This biologic provides rapid and sustained control of symptoms of GPP flare, although its use in pregnant women has not been reported to date. Here, we report a pregnant woman with refractory GPP who did not respond well to systemic steroids. Administration of spesolimab resulted in complete control of the disease and the birth of a healthy baby. Our case demonstrates that IL-36RN inhibitors are a potentially effective and safe treatment option for GPP in pregnancy.
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Affiliation(s)
- Chenxin Yang
- Department of Dermatology, Peking University First Hospital, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
| | - Yang Wang
- Department of Dermatology, Peking University First Hospital, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
| | - Ruoyu Li
- Department of Dermatology, Peking University First Hospital, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
| | - Ping Tu
- Department of Dermatology, Peking University First Hospital, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
| | - Ruojun Wang
- Department of Dermatology, Peking University First Hospital, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
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2
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Wang Y, Zhou C, Hou Y, Gao Y, Lu J, Yin Z. Biologic treatment outcomes in generalized pustular psoriasis of pregnancy: A systematic review. Australas J Dermatol 2024. [PMID: 39087458 DOI: 10.1111/ajd.14357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/28/2024] [Accepted: 07/21/2024] [Indexed: 08/02/2024]
Affiliation(s)
- YuFei Wang
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - ChaoJing Zhou
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - YiYun Hou
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - YaMei Gao
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - JiLiang Lu
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - ZhiQiang Yin
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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3
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Rivera-Díaz R, Carrascosa Carrillo JM, Alfonso Zamora S, Navarro Valdivieso JP, Muñoz Cabello B, Ros Abarca S, Soria de Francisco JM, Daudén Tello E. [Translated article] Improvements in the Management of Patients With Generalized Pustular Psoriasis in Spain: Recommendations From a Group of Experts. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00585-4. [PMID: 38972580 DOI: 10.1016/j.ad.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/28/2024] [Accepted: 04/16/2024] [Indexed: 07/09/2024] Open
Abstract
This consensus document analyzed the management and emotional journey of patients with GPP (generalized pustular psoriasis), and the desirable course of the disease while detecting critical points and translating them into needs and recommendations. This project was conducted in 3 phases with participation from an advisory committee (n=8), an expert panel (n=15) and patients with GPP (n=6). The patients' disease progression was heterogeneous due to disease variations, different health care models implemented and available resources, and the lack of diagnostic and treatment guidelines. A total of 45 different recommendations have been made to optimize management and address the emotional component of these patients. Five of them stand out for their impact and viability. Therefore, a roadmap of priorities has been made generally available to improve the management of patients with GPP.
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Affiliation(s)
- R Rivera-Díaz
- Servicio de Dermatología, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain.
| | - J M Carrascosa Carrillo
- Servicio de Dermatología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | - J P Navarro Valdivieso
- Técnico Gerencia Adjunta de Ordenación Asistencia e Innovación Organizativa, Servicio Madrileño de Salud (SERMAS)-Inmunología Ruber Internacional, Madrid, Spain
| | - B Muñoz Cabello
- Sección de Neuropediatría, Hospital Virgen del Rocío, Sevilla, Spain
| | - S Ros Abarca
- Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - E Daudén Tello
- Servicio de Dermatología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de la Princesa (IIS-IP), Madrid, Spain
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4
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Rivera-Díaz R, Carrascosa Carrillo JM, Alfonso Zamora S, Navarro Valdivieso JP, Muñoz Cabello B, Ros Abarca S, Soria de Francisco JM, Daudén Tello E. Improvements in the Management of Patients With Generalized Pustular Psoriasis in Spain: Recommendations From a Group of Experts. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00416-2. [PMID: 38777227 DOI: 10.1016/j.ad.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/28/2024] [Accepted: 04/16/2024] [Indexed: 05/25/2024] Open
Abstract
This consensus document analyzed the management and emotional journey of patients with GPP (generalized pustular psoriasis), and the desirable course of the disease while detecting critical points and translating them into needs and recommendations. This project was conducted in 3 phases with participation from an advisory committee (n=8), an expert panel (n=15) and patients with GPP (n=6). The patients' disease progression was heterogeneous due to disease variations, different health care models implemented and available resources, and the lack of diagnostic and treatment guidelines. A total of 45 different recommendations have been made to optimize management and address the emotional component of these patients. Five of them stand out for their impact and viability. Therefore, a roadmap of priorities has been made generally available to improve the management of patients with GPP.
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Affiliation(s)
- R Rivera-Díaz
- Servicio de Dermatología, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, España.
| | - J M Carrascosa Carrillo
- Servicio de Dermatología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, España
| | | | - J P Navarro Valdivieso
- Técnico Gerencia Adjunta de Ordenación Asistencia e Innovación Organizativa, Servicio Madrileño de Salud (SERMAS)-Inmunología Ruber Internacional, Madrid, España
| | - B Muñoz Cabello
- Sección de Neuropediatría, Hospital Virgen del Rocío, Sevilla, España
| | - S Ros Abarca
- Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | - E Daudén Tello
- Servicio de Dermatología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de la Princesa (IIS-IP), Madrid, España
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5
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Wu H, Shen YN, Wu Z, Mao F, Ren YG, Zhang L. Ustekinumab in the Treatment of Generalized Pustular Psoriasis in a Pregnant Patient. Clin Cosmet Investig Dermatol 2024; 17:1107-1110. [PMID: 38765193 PMCID: PMC11102752 DOI: 10.2147/ccid.s451738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 04/08/2024] [Indexed: 05/21/2024]
Abstract
Although the use of biologics has led to great improvement in psoriasis patients, the treatment of psoriasis during pregnancy still faces many challenges. We herein report on a 29-year-old pregnant woman treated with ustekinumab for generalized pustular psoriasis. Upon becoming pregnant, the woman underwent continued treatment with ustekinumab in the first trimester. We also considered the need for neonatal vaccination. The patient discontinued ustekinumab therapy in the second trimester, and during the period of drug discontinuation we noted a slight rash recurrence. The patient was treated with ultraviolet B phototherapy and topical corticosteroids, and the rash was localized to the abdomen. However, in the 27th week of pregnancy, the patient was infected with COVID-19, which made the condition worse. The rash erupted rapidly and spread throughout her body, and she experienced a high fever with her blood count showing augmented numbers of white blood cells. The patients self-administered 0.3 g of acetaminophen three times per day, and after four days her core body temperature was 38.0°C; the rash, however, did not diminish. We diagnosed an outbreak of generalized pustular psoriasis and treated the patient with ustekinumab. The rash resolved quickly, and a healthy newborn was delivered by caesarean section at 39 weeks.
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Affiliation(s)
- Hao Wu
- Department of Dermatology, Ningbo No 6 Hospital, Ningbo, 315040, People’s Republic of China
| | - Yan Na Shen
- Department of Dermatology, Ningbo No 6 Hospital, Ningbo, 315040, People’s Republic of China
| | - Zhongxiao Wu
- Department of Dermatology, Ningbo No 6 Hospital, Ningbo, 315040, People’s Republic of China
| | - Feng Mao
- Department of Dermatology, Ningbo No 6 Hospital, Ningbo, 315040, People’s Republic of China
| | - You Gang Ren
- Department of Dermatology, Ningbo No 6 Hospital, Ningbo, 315040, People’s Republic of China
| | - Li Zhang
- Department of Dermatology, Ningbo No 6 Hospital, Ningbo, 315040, People’s Republic of China
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Hsieh CY, Tsai YJ, Tsai TF. Use of biologics in Chinese pregnant patients with deficiency of interleukin-36 receptor antagonist (DITRA): A case series. Taiwan J Obstet Gynecol 2024; 63:405-408. [PMID: 38802208 DOI: 10.1016/j.tjog.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVE Impetigo herpetiformis (IH) is a rare form of pustular psoriasis which may result in maternal and fetal morbidity and even mortality. Deficiency of interleukin-36 receptor antagonist (DITRA) is the most frequently identified genetic defect of IH. Currently there are no biologics approved for IH despite the revolutionary role of biologics in the treatment of plaque and pustular psoriasis. Anecdotal reports of biologics use in DITRA patients with IH are also limited. CASE REPORTS We present herein a case series of 6 Chinese IH patients harboring IL36RN gene c.115+6T>C mutation during 8 pregnancies, treated with various biologics, including adalimumab, etanercept and secukinumab. CONCLUSION Most pregnancy courses were uneventful, except for one woman who had recurrent episodes of decreased fetal heart rate variability after adalimumab injections, which subsided after switching to etanercept. The treatment effectiveness and safety demonstrated in our cases suggested the role of biologics for the treatment of IH in patients with DITRA.
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Affiliation(s)
- Chang-Yu Hsieh
- Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan.
| | - Yun-Ju Tsai
- Department of Dermatology, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan.
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan.
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Lo A, Thompson B, Sami N. Rare Autoinflammatory Neutrophilic Dermatoses in Pregnancy: Literature Review. Am J Clin Dermatol 2024; 25:227-242. [PMID: 38091248 DOI: 10.1007/s40257-023-00830-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 02/16/2024]
Abstract
Rare cases of autoinflammatory neutrophilic dermatoses (AINDs) have been reported in patients during pregnancy with associated adverse maternal and fetal outcomes. Due to the rarity and heterogeneous morphology of pregnancy-associated AINDs, clinical diagnosis is often overlooked, and treatment options are limited. In this review, we present the epidemiology, clinical characteristics, therapeutic interventions, maternal and fetal outcomes, and discuss the possible pathophysiology of various pregnancy associated AINDs. Risk factors for the onset and exacerbation of AINDs in pregnancy include older maternal age, disease duration, and specific gestational age. The varied disease courses and conflicting clinical outcomes in both mothers and fetuses demonstrate the importance of symptom recognition and the understanding of the role of pregnancy on AINDs.
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Affiliation(s)
- Angela Lo
- University of Central Florida College of Medicine, Orlando, FL, USA
| | | | - Naveed Sami
- Department of Internal Medicine, University of Central Florida College of Medicine, Health Sciences Campus at Lake Nona, Orlando, FL, 32827-7408, USA.
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Hsieh CY, Tsai TF. Clinical advances in biological therapy for generalized pustular psoriasis: a review. Expert Opin Biol Ther 2024; 24:37-50. [PMID: 38247394 DOI: 10.1080/14712598.2024.2309301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/19/2024] [Indexed: 01/23/2024]
Abstract
INTRODUCTION In 2022, U.S. Food and Drug Administration (FDA) approved the first biologics, intravenous spesolimab, for acute flare of generalized pustular psoriasis (GPP). The drug works by blocking IL-36 signaling, the key pathway of GPP. Among the known mutations causing GPP, IL36RN mutations are most common, and the presence of IL36RN mutations had been found to affect the clinical manifestations and treatment response of GPP. AREAS COVERED Literature search was conducted in PubMed, Embase and ClinicalTrials.gov for relevant studies discussing biologic treatment for GPP with special emphasis on larger studies, pediatric group, pregnant women, and the influence of IL36RN mutation on the effectiveness of biologics. EXPERT OPINION The approval of spesolimab for GPP flare treatment marks a new era. However, whether spesolimab will be placed as the treatment of choice remains unknown, considering its higher cost, lack of direct comparison with existing biologics, and uncertain effects on co-existing plaque-type psoriasis. However, the demonstration of numerically better efficacy for patients carrying pathogenic IL36RN mutations suggests the role of pharmacogenetics in the choices of GPP treatment. Future randomized studies are warranted to investigate the effectiveness and safety of biologics for GPP in pediatric and pregnant groups.
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Affiliation(s)
- Chang-Yu Hsieh
- Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan
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Xu Z, Liu Y, Qu H, Bai Y, Ma J, Hao J, Yu C, Dang E, Wang G, Shao S. Clinical characteristics and heterogeneity of generalized pustular psoriasis: A comparative study in a large retrospective cohort. Exp Dermatol 2024; 33:e14891. [PMID: 37493071 DOI: 10.1111/exd.14891] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/05/2023] [Accepted: 07/09/2023] [Indexed: 07/27/2023]
Abstract
Generalized pustular psoriasis (GPP) is a rare and potentially life-threatening skin disease and the clinical heterogeneity of which is largely unknown. Retrospective cohort analysis was conducted on hospitalized GPP patients between January 2010 and November 2022. A total of 416 patients with GPP and psoriasis vulgaris (PV) respectively were included, matched 1:1 by sex and age. The heterogeneity of GPP was stratified by PV history and age. Compared with PV, GPP was significantly associated with prolonged hospitalization (11.7 vs. 10.3 day, p < 0.001), elevated neutrophil lymphocyte ratio (NLR) (5.93 vs. 2.44, p < 0.001) and anemia (13.9% vs. 1.2%, p < 0.001). Moreover, GPP alone (without PV history) was a relatively severer subtype with higher temperature (37.6°C vs. 38.0°C, p = 0.002) and skin infections (5.2% vs. 11.4%, p = 0.019) than GPP with PV. For patients across different age, compared with juvenile patients, clinical features support a severer phenotype in middle-aged, including higher incidence of anaemia (7.5% vs. 16.0%, p = 0.023) and NLR score (3.83 vs. 6.88, p < 0.001). Interleukin-6 (r = 0.59), high density lipoprotein cholesterol (r = -0.56), albumin (r = -0.53) and C-reactive protein-to-albumin ratio (r = 0.49) were the most relevant markers of severity in GPP alone, GPP with PV, juvenile and middle-aged GPP, respectively. This retrospective cohort suggests that GPP is highly heterogeneous and GPP alone and middle-aged GPP exhibit severe disease phenotypes. More attention on the heterogeneity of this severe disease is warranted to meet the unmet needs and promote the individualized management of GPP.
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Affiliation(s)
- Zhongrui Xu
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi, China
| | - Yanhua Liu
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi, China
| | - Huanhuan Qu
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi, China
| | - Yaxing Bai
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi, China
| | - Jingyi Ma
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi, China
| | - Junfeng Hao
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi, China
| | - Chen Yu
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi, China
| | - Erle Dang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi, China
| | - Gang Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi, China
| | - Shuai Shao
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi, China
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Xie F, Agrawal S, Johnson EF, Wieland CN, Davis DMR, Theiler RN, Lehman JS. Updates on the dermatopathology of pregnancy-associated skin conditions. Hum Pathol 2023; 140:173-195. [PMID: 37209919 DOI: 10.1016/j.humpath.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/15/2023] [Indexed: 05/22/2023]
Abstract
Pathologists provide valuable input in the dermatological care of pregnant patients in various contexts. This article provides dermatopathology updates on cutaneous changes associated with pregnancy, organized based on the following classification system: physiological skin changes in pregnancy, specific dermatoses of pregnancy, dermatoses modified in pregnancy, and skin neoplasms in pregnancy. Awareness of the impact of pregnancy on the skin by pathologists is important, as this is an opportunity to contribute to diagnostic precision in this patient population.
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Affiliation(s)
- Fangyi Xie
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Shruti Agrawal
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Emma F Johnson
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Carilyn N Wieland
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Dawn Marie R Davis
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Regan N Theiler
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Julia S Lehman
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
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Choon SE, Elewski BE, Fujita H, Geng S, van de Kerkhof P, Mburu S, Puig L, Romiti R, Venturini M. Diversity in the clinical presentation of generalized pustular psoriasis (GPP): A series of case vignettes from around the world. Exp Dermatol 2023; 32:1284-1295. [PMID: 36999936 DOI: 10.1111/exd.14794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 02/19/2023] [Indexed: 04/01/2023]
Abstract
A key principle of clinical studies and case reports is that they should reflect the demographics and epidemiology of the patient population concerned. Here, we have compiled a diverse group of clinical cases of generalized pustular psoriasis (GPP) to showcase the differences in GPP presentation in patients worldwide. We attempt to capture the broad spectrum of clinical presentations of GPP and showcase the diversity of the patient population. The patients included in this series are diverse in age, genetic background, skin phototype and medical history. Moreover, they present with a variety of clinical courses of GPP and different degrees of systemic involvement, and experience flares triggered by different inciting factors. The key learnings from this case series may support physicians in identifying and managing patients with this rare and multifaceted disease that can affect patients both physically and psychologically.
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Affiliation(s)
- Siew Eng Choon
- Department of Dermatology, Hospital Sultanah Aminah, and Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia
| | - Boni E Elewski
- University of Alabama School of Medicine, Birmingham, Alabama, USA
| | | | - Songmei Geng
- Second Hospital Affiliated to Xi'an Jiaotong University, Xi'an, China
| | | | - Sicily Mburu
- IFPA (International Federation of Psoriasis Associations), Stockholm, Sweden
| | - Lluís Puig
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ricardo Romiti
- Department of Dermatology, University of São Paulo, São Paulo, Brazil
| | - Marina Venturini
- Department of Dermatology ASST-Spedali Civili Hospital, University of Brescia, Brescia, Italy
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