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Pathak GN, Wang E, Dhillon J, Parikh PN, Esseghir R, Rao BK, Feldman SR. Spesolimab: A Review of the First IL-36 Blocker Approved for Generalized Pustular Psoriasis. Ann Pharmacother 2024:10600280241252688. [PMID: 38755971 DOI: 10.1177/10600280241252688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVE This article reviews clinical trial data that assesses the safety, efficacy, and clinical application of spesolimab, an interleukin-36 (IL-36) blocker, for the treatment of generalized pustular psoriasis (GPP). DATA SOURCES A review of the literature was conducted using the search terms: "spesolimab," "BI 655130," and "spevigo" in MEDLINE (PubMed) and Clinicaltrials.gov from January 1, 1950 to October 31, 2023. STUDY SELECTION AND DATA EXTRACTION Relevant articles in English relating to the pharmacodynamics, pharmacokinetics, efficacy, and safety of spesolimab were included. DATA SYNTHESIS In one phase 2 clinical trial evaluating single dose IV spesolimab for GPP flares at day 8, 54% of patients receiving spesolimab had a GPP physician global assessment (GPPGA) pustulation subscore of 0, and 43% had a GPPGA total score of 0 compared with 6% and 11% for the placebo group, respectively. Another phase 2 clinical trial assessing subcutaneous spesolimab found 23% of patients in low-dose, 29% in medium-dose, and 10% of high-dose spesolimab had flares by week 48 compared with 52% of the placebo group. Hazard ratios for time to GPP flare compared with placebo were 0.16 (P = 0.0005), 0.35 (P = 0.0057), and 0.47 (P = 0.027) for the spesolimab groups, respectively. Infection rates were similar across treatment and placebo groups, and severe adverse events such as drug reactions with eosinophilia and systemic symptom (DRESS), cholelithiasis, and breast cancer occurred with spesolimab. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE IN COMPARISON TO EXISTING DRUGS Spesolimab is a first-in-class IL-36 monoclonal antibody receptor antagonist approved for the treatment of acute GPP flares. It is a safe and effective therapeutic agent in preventing future GPP flares, with no current comparator trials with other GPP agents. CONCLUSION Spesolimab is a safe and effective treatment for acute GPP flares in adults. Future clinical trials can establish safety and efficacy compared with other agents.
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Affiliation(s)
- Gaurav N Pathak
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, USA
- Center for Dermatology Research, Department of Dermatology, School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Emily Wang
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, USA
| | - Jimmy Dhillon
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, USA
| | - Prachi N Parikh
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, USA
| | - Reem Esseghir
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, USA
| | - Babar K Rao
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, USA
- Department of Dermatology, Rao Dermatology, Atlantic Highlands, NJ, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, School of Medicine, Wake Forest University, Winston-Salem, NC, USA
- Department of Pathology, School of Medicine, Wake Forest University, Winston-Salem, NC, USA
- Department of Social Sciences and Health Policy, School of Medicine, Wake Forest University, Winston-Salem, NC, USA
- Department of Dermatology, University of Southern Denmark, Odense, Denmark
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Hsieh CY, Tsai TF. Is pustular psoriasis a potentially scarring dermatosis? Ital J Dermatol Venerol 2024; 159:207-208. [PMID: 38436614 DOI: 10.23736/s2784-8671.24.07736-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Affiliation(s)
- Chang-Yu Hsieh
- Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China -
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van Ierland K, Vredevoogd C, Roach R, Clahsen P. Severe case of pustular psoriasis during pregnancy. BMJ Case Rep 2024; 17:e258198. [PMID: 38508599 PMCID: PMC10952864 DOI: 10.1136/bcr-2023-258198] [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] [Indexed: 03/22/2024] Open
Abstract
Pustular psoriasis of pregnancy (PPP) is a rare variant of generalised pustular psoriasis occurring during or after pregnancy. PPP can have significant maternal and fetal morbidity if left untreated. In this case report, we present a pregnant woman with this rare cutaneous disorder and how it was treated. Due to the limited available evidence regarding the treatment of PPP, we describe the treatment that was given based on the clinical manifestations and severity of the disease.
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Affiliation(s)
| | - Corla Vredevoogd
- Gynaecology and Obstetrics, Medisch Centrum Haaglanden Westeinde, Den Haag, The Netherlands
| | - Rachel Roach
- Dernatology, Medisch Centrum Haaglanden Westeinde, Den Haag, The Netherlands
| | - Pieter Clahsen
- Pathology, HMC Westeinde Hospital, Den Haag, The Netherlands
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4
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Zhao M, Huang F, Tang L, Zhou X, Zhang M, Liao M, Liu L, Huang M. Case report: Successful treatment of acute generalized pustular psoriasis with multiple comorbidities with oral tacrolimus. Front Immunol 2024; 15:1354578. [PMID: 38566985 PMCID: PMC10985253 DOI: 10.3389/fimmu.2024.1354578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Acute generalized pustular psoriasis (GPP) is a serious illness. Despite various treatment methods, there is still lack of effective treatment plans for refractory cases with multiple comorbidities. This case report presents a 67-year-old woman with acute GPP, stage 4 chronic kidney disease (CKD), type 2 diabetes, and cardiovascular disease, in whom skin symptom disappearance and kidney function improvement were observed after the use of oral tacrolimus as the sole therapy. This is the first report on the application of tacrolimus in the treatment of acute GPP, especially refractory acute GPP. The successful treatment indicates that there are shared immune pathways between acute GPP and CKD, and the pathways can be interdicted by tacrolimus. Further studies are needed to optimize the therapy to maximize efficacy and minimize toxicity.
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Affiliation(s)
- Mingdan Zhao
- Department of Dermatology and Cosmetology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Fujun Huang
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
| | - Lei Tang
- Department of Dermatology and Cosmetology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Xun Zhou
- Department of Dermatology and Cosmetology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Miao Zhang
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
| | - Mengxue Liao
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
| | - Lirong Liu
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
| | - Mengya Huang
- Department of Dermatology and Cosmetology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
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5
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Chayama R, Amano S, Ofuji S, Sano C, Ohta R. Concurrent Presentation of Pustular Psoriasis and Late-Onset Rheumatoid Arthritis: A Diagnostic Challenge in a Community Hospital Setting. Cureus 2023; 15:e50278. [PMID: 38196439 PMCID: PMC10775951 DOI: 10.7759/cureus.50278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2023] [Indexed: 01/11/2024] Open
Abstract
The coexistence of autoimmune diseases presents a significant diagnostic challenge in clinical practice, particularly in settings with limited resources. This case report details a rare instance of pustular psoriasis occurring concurrently with rheumatoid arthritis, underscoring the complexities involved in diagnosing overlapping autoimmune disorders. A 70-year-old male with a history of chronic heart failure, atrial fibrillation, and other comorbidities presented to a rural community hospital with a year-long persistent rash and joint and back pain. Physical examination and blood tests revealed high inflammatory markers. A dermatological assessment, including a skin biopsy, diagnosed generalized pustular psoriasis. However, the atypical presentation of acute polyarthritis led to further investigations, revealing elevated rheumatoid factor and anti-citrullinated protein antibody levels, resulting in a diagnosis of late-onset rheumatoid arthritis. The patient underwent a comprehensive treatment regime, including prednisolone, cefazolin, oral terbinafine, methotrexate, and infliximab, leading to gradual symptom improvement to the previous activity of daily life and discharge on the 27th day of hospitalization. This case illustrates the diagnostic intricacies in identifying concurrent autoimmune disorders and highlights the crucial role of general physicians in systematically approaching complex cases in resource-limited settings. It emphasizes the need for heightened clinical vigilance and a multifaceted diagnostic approach when managing patients with overlapping rheumatic symptoms, advocating for consideration of coexisting conditions in autoimmune diseases.
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Affiliation(s)
- Ryoka Chayama
- Family Medicine, Shimane Prefectural Central Hospital, Izumo, JPN
| | - Shiho Amano
- Community Care, Unnan City Hospital, Unnan, JPN
| | | | - Chiaki Sano
- Community Medicine Management, Shimane University Faculty of Medicine, Izumo, JPN
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Bhagwat AP, Madke B. The Current Advancement in Psoriasis. Cureus 2023; 15:e47006. [PMID: 37965393 PMCID: PMC10642617 DOI: 10.7759/cureus.47006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/13/2023] [Indexed: 11/16/2023] Open
Abstract
The study on psoriasis disease helps improve the condition and treatment options day by day in dermatology. In the current scenario, research is ongoing to make the best interventions possible for managing the disease. Psoriasis is one of the most common dermatological conditions wherein chronic inflammation of the skin occurs, characterized by the formation of a rash with scaly, itchy patches over the body surface. The condition is mainly related to the immune system wherein epidermal hyperplasia occurs with infiltration of immune cells. Many factors can trigger psoriasis. Environmental, emotional, hereditary, and personal habits are responsible for the conditions. The current research helps to gain a complete understanding, and the basic knowledge of the state with recent advancements in treatment strategies and characteristic features can also be studied. The main aim is to know the disease's primary root cause and management. It involves the main sites of the body. The most commonly affected parts are the scalp, trunks, knees, elbow, and ankle. It is a chronic long-term disease. Sometimes it may be painful. Itching, bleeding, and disturbed sleep patterns are common symptoms. Most commonly involves the upper epidermal surface. The prevalence of the condition has been increased as it is associated with other comorbidities. The main focus of the treatment is to restrict skin cell multiplication and remove scaly surfaces. This review discusses the advancement in the treatment, its initiation, progression, current symptoms, and disease development. The study also includes basic knowledge about the types of psoriatic disease with its specific features and mechanisms.
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Affiliation(s)
- Aishwarya P Bhagwat
- Dermatology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Bhushan Madke
- Dermatology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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7
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Mohd Affandi A, Baharom ZF. Case report-Subcorneal pustular dermatosis-A great mimicker of generalized pustular psoriasis. Exp Dermatol 2023; 32:1308-1311. [PMID: 37000973 DOI: 10.1111/exd.14800] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/17/2023] [Accepted: 03/13/2023] [Indexed: 04/03/2023]
Affiliation(s)
- A Mohd Affandi
- Department of Dermatology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Z F Baharom
- Department of Pathology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
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8
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Potestio L, Camela E, Cacciapuoti S, Martora F, Guerriero L, Fornaro L, Ruggiero A, Megna M. Efficacy and safety of spesolimab for the management of generalized pustular psoriasis: a drug safety evaluation. Expert Opin Drug Saf 2023; 22:1003-1010. [PMID: 37768729 DOI: 10.1080/14740338.2023.2265295] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/27/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Generalized pustular psoriasis (GPP) is a rare form of psoriasis (less of 1% of cases). Currently, GPP is recognized as a clinical entity, distinguished from plaque psoriasis. However, there are not guidelines for GPP management and treatments are often derived from plaque psoriasis. Therefore, conventional systemic drugs are usually used as first-line treatment options, and biologics are still used off label. Recently, spesolimab, an anti-IL36 receptor humanized IgG1 monoclonal antibody, has been specifically approved for GPP disease, revolutionizing treatment scenario. AREAS COVERED The aim of this review is to investigate current literature on the use of spesolimab for GPP management to underline its potential role in GPP and offer a current clinical perspective. Literature research using the Google Scholar, Pubmed, Embase, Cochrane Skin, and clinicaltrials.gov databases was performed, selecting the most relevant manuscripts. EXPERT OPINION Spesolimab is efficacious and has a consistent and favorable safety profile in patients presenting with a GPP flare. However, despite excellent results in terms of safety and efficacy have been reported by both clinical trials and very limited real-life experiences, long-term data, especially in flare-up prevention, are scant. Thus, while the available data are encouraging, further research is warranted to understand the efficacy, safety, and long-term outcomes associated with spesolimab treatment in GPP.
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Affiliation(s)
- Luca Potestio
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Elisa Camela
- Dermatology Unit, Istituto Dermopatico dell'Immacolata - IRCCS, Rome, Italy
| | - Sara Cacciapuoti
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Fabrizio Martora
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luigi Guerriero
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luigi Fornaro
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Angelo Ruggiero
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Matteo Megna
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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9
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Parisi R, Shah H, Navarini AA, Muehleisen B, Ziv M, Shear NH, Dodiuk-Gad RP. Acute Generalized Exanthematous Pustulosis: Clinical Features, Differential Diagnosis, and Management. Am J Clin Dermatol 2023:10.1007/s40257-023-00779-3. [PMID: 37156992 PMCID: PMC10166469 DOI: 10.1007/s40257-023-00779-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 05/10/2023]
Abstract
Acute generalized exanthematous pustulosis (AGEP) is a rare, acute, severe cutaneous adverse reaction mainly attributed to drugs, although other triggers, including infections, vaccinations, ingestion of various substances, and spider bites, have also been described. AGEP is characterized by the development of edema and erythema followed by the eruption of multiple punctate, non-follicular, sterile pustules and subsequent desquamation. AGEP typically has a rapid onset and prompt resolution within a few weeks. The differential diagnoses for AGEP are broad and include infectious, inflammatory, and drug-induced etiologies. Diagnosis of AGEP depends on both clinical and histologic criteria, as cases of overlap with other disease processes have been reported. Management includes removal of the offending drug or treatment of the underlying cause, if necessary, and supportive care, as AGEP is a self-limited disease. This review aims to provide an overview and update on the epidemiology, pathogenesis, reported precipitating factors, differentials, diagnosis, and management of AGEP.
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Affiliation(s)
- Rose Parisi
- Albany Medical College, Albany, New York, NY, USA
| | - Hemali Shah
- Albany Medical College, Albany, New York, NY, USA
| | - Alexander A Navarini
- Department of Dermatology and Allergy, University Hospital of Basel, Basel, Switzerland
| | - Beda Muehleisen
- Department of Dermatology and Allergy, University Hospital of Basel, Basel, Switzerland
| | - Michael Ziv
- Department of Dermatology, Emek Medical Center, Afula, Israel
| | - Neil H Shear
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, M5S 1A1, Canada
| | - Roni P Dodiuk-Gad
- Department of Dermatology, Emek Medical Center, Afula, Israel.
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, M5S 1A1, Canada.
- Department of Dermatology, Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, 3525433, Israel.
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Montero-Vilchez T, Grau-Perez M, Garcia-Doval I. Epidemiology and Geographic Distribution of Generalized Pustular Psoriasis in Spain: A National Population-Based Study of Hospital Admissions from 2016 to 2020. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:97-101. [PMID: 36206810 DOI: 10.1016/j.ad.2022.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/24/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Little has been published on the epidemiology of generalized pustular psoriasis (GPP). The aim of this study was to describe and analyze the geographic distribution of hospital admissions for GPP in Spain. METHODS We performed a cross-sectional study using the hospital discharge database of the Spanish Basic Minimum Data Set (CMBD), which is a mandatory data set of all admissions to public hospitals in the country. We included patients with a primary diagnosis of psoriasis or GPP at discharge for the period 2016 to 2020. We performed a descriptive analysis of clinical and sociodemographic characteristics of patients admitted with GPP, a spatial analysis at the province level assessing the presence of geographic heterogeneity and a GPP disease map. RESULTS We detected 949 diagnoses of psoriasis and 744 primary diagnoses of GPP. Mean age of patients admitted with GPP was 62.2 years. Intensive care unit admissions were ordered for 6.1% of patients and 4.8% died. The overall incidence rate of GPP among newly hospitalized patients during the study period was 3.18 cases per 1,000,000 person-years. The geographic distribution varied widely, with higher rates observed in the north-west of the country. CONCLUSIONS We describe the characteristics of GPP hospitalized patients in Spain and provide the first disease map for the country. The findings could help guide future research and suggest the possibility of genetic or environmental factors driving geographic differences.
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Affiliation(s)
| | - M Grau-Perez
- Unidad de Investigación, Fundación Piel Sana, Academia Española de Dermatología y Venereología (AEDV), Madrid, España.
| | - I Garcia-Doval
- Unidad de Investigación, Fundación Piel Sana, Academia Española de Dermatología y Venereología (AEDV), Madrid, España
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Montero-Vilchez T, Grau-Perez M, Garcia-Doval I. [Translated article] Epidemiology and Geographic Distribution of Generalized Pustular Psoriasis in Spain: A National Population-Based Study of Hospital Admissions from 2016 to 2020. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T97-T101. [PMID: 36464011 DOI: 10.1016/j.ad.2022.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/24/2022] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Little has been published on the epidemiology of generalized pustular psoriasis (GPP). The aim of this study was to describe and analyze the geographic distribution of hospital admissions for GPP in Spain. METHODS We performed a cross-sectional study using the hospital discharge database of the Spanish Basic Minimum Data Set (CMBD), which is a mandatory data set of all admissions to public hospitals in the country. We included patients with a primary diagnosis of psoriasis or GPP at discharge for the period 2016-2020. We performed a descriptive analysis of clinical and sociodemographic characteristics of patients admitted with GPP, a spatial analysis at the province level assessing the presence of geographic heterogeneity and a GPP disease map. RESULTS We detected 949 diagnoses of psoriasis and 744 primary diagnoses of GPP. Mean age of patients admitted with GPP was 62.2 years. Intensive care unit admissions were ordered for 6.1% of patients and 4.8% died. The overall incidence rate of newly hospitalized GPP patients during the study period was 3.18 cases per 1,000,000 person-years. The geographic distribution varied widely, with higher rates observed in the north-west of the country. CONCLUSIONS We describe the characteristics of GPP hospitalized patients in Spain and provide the first disease map for the country. The findings could help guide future research and suggest the possibility of genetic or environmental factors driving geographic differences.
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Affiliation(s)
| | - M Grau-Perez
- Unidad de Investigación, Fundación Piel Sana, Academia Española de Dermatología y Venereología (AEDV), Madrid, Spain.
| | - I Garcia-Doval
- Unidad de Investigación, Fundación Piel Sana, Academia Española de Dermatología y Venereología (AEDV), Madrid, Spain
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Generalized Pustular Psoriasis: A Review on Clinical Characteristics, Diagnosis, and Treatment. Dermatol Ther (Heidelb) 2023; 13:673-688. [PMID: 36635445 PMCID: PMC9836924 DOI: 10.1007/s13555-022-00881-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/19/2022] [Indexed: 01/14/2023] Open
Abstract
Generalized pustular psoriasis (GPP) is a rare, chronic, and severe inflammatory skin disorder characterized by sudden eruption of sterile pustules, often accompanied by systemic inflammation. GPP flares can be life-threatening if untreated, owing to potential serious complications such as sepsis and cardiovascular failure. Diagnosis and clinical measurement of disease severity in GPP are often difficult. Lack of standardized criteria in the international guidelines and the heterogeneity of cutaneous and extracutaneous symptoms make the diagnosis of GPP difficult. Clinical criteria for description and diagnosis of pustular conditions, including GPP, are variable and there is no specific agreement on commonly sustained concepts. Differentiation of GPP from other similar conditions/diseases is important and requires careful assessments. The evidence that supports current topical or systemic therapies is largely based on case reports and small studies. Some biologic agents that target key cytokines involved in the activation of inflammatory pathways have been used as treatments for GPP. Recently, spesolimab, an IL-36R antagonist, has been approved in the USA and Japan for the treatment of GPP flares in adults, but there are no currently approved treatments for GPP in Europe. The IL-36 pathway has recently emerged as a central axis driving the pathogenic inflammatory mechanisms of GPP. Biologic agents that inhibit the IL-36 pathway have shown efficacy and safety in patients with GPP, addressing a generally considered unmet medical need.
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Lu J, Shi Y. A review of disease burden and clinical management for generalized pustular psoriasis in China. Expert Rev Clin Immunol 2022; 18:1023-1032. [PMID: 36040447 DOI: 10.1080/1744666x.2022.2118716] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Generalized pustular psoriasis (GPP) is a rare, severe, immune-mediated and potentially life-threatening skin disease. The rarity, differential diagnoses, relapsing nature, skin and systemic symptoms, complications and limited therapeutic approaches for this disease pose a clinical and psychological burden on patients and their families. AREAS COVERED Epidemiologic data of GPP in Chinese patients, including the disease prevalence and age of disease onset, as well as epidemiologic data in global populations were reviewed. Multiple proinflammatory cytokines are involved in the disease development and clinical presentation of GPP and the interleukin (IL)-36-mediated signalling pathway play a central role. Furthermore, loss-of-function mutations in IL-36RN (encoding the IL-36 receptor antagonist) are associated with GPP, suggesting a potential drug target for developing a disease-specific therapeutic approach. Biologic agents, including IL-36R targeted agents, are promising treatment options, especially as existing conventional therapies are inadequate. Chinese guidelines for the diagnosis and treatment of psoriasis recommend systemic and topical treatment options for GPP and disease complications, as well as for GPP during pregnancy and juvenile GPP. EXPERT OPINION This review summarizes the epidemiology, pathogenesis, clinical characteristics, disease burden and management of patients with GPP in China, and also describes future treatment targets and related clinical trials.
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Affiliation(s)
- Jiajing Lu
- Department of Dermatology, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Baode Rd 1278, Shanghai 200443, China
| | - Yuling Shi
- Department of Dermatology, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Baode Rd 1278, Shanghai 200443, China.,Department of Dermatology, Institute of Psoriasis, School of Medicine, Tongji University, Baode Rd 1278, Shanghai 200072, China
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