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Teshima R, Saito-Sasaki N, Sawada Y. Generalized Pustular Psoriasis and Systemic Organ Dysfunctions. Int J Mol Sci 2024; 25:6270. [PMID: 38892457 PMCID: PMC11172751 DOI: 10.3390/ijms25116270] [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: 04/29/2024] [Revised: 06/02/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024] Open
Abstract
This review explores the intricate relationship between generalized pustular psoriasis (GPP) and various systemic diseases, shedding light on the broader impacts of this severe skin condition beyond its primary dermatological manifestations. GPP is identified as not only a profound contributor to skin pathology but also a significant risk factor for systemic diseases affecting cardiovascular, hepatic, renal, pulmonary, and skeletal systems, as well as associated with an increased incidence of anemia, depression, anxiety, and arthritis. The research highlights the complex interplay of cytokines, particularly IL-17 and IL-36, which are central to the pathophysiology of GPP and implicated in the exacerbation of systemic conditions. Key findings indicate a higher incidence of cardiovascular events in GPP patients compared to those with other severe forms of psoriasis, notably with a stronger correlation between myocardial infarction history and GPP development. Liver disturbances, frequently reversible upon psoriasis remission, suggest a cytokine-mediated link to hepatic health. Renal dysfunction appears elevated in GPP sufferers, with IL-17 and IL-36 potentially driving renal fibrosis. Similarly, interstitial lung disease and osteoporosis in GPP patients underscore the systemic reach of inflammatory processes initiated in the skin. The associations with anemia, depression, anxiety, and arthritis further complicate the clinical management of GPP, requiring a multidisciplinary approach. The study concludes that managing GPP effectively requires a holistic approach that addresses both the cutaneous and systemic dimensions of the disease, advocating for continued research into the mechanisms that connect GPP with broader health implications to refine therapeutic strategies.
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Affiliation(s)
| | | | - Yu Sawada
- Department of Dermatology, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan
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2
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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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3
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Lim LY, Oon HH. Gastrointestinal and hepatic manifestations in patients with generalised pustular psoriasis. Exp Dermatol 2023; 32:1246-1252. [PMID: 36779689 DOI: 10.1111/exd.14766] [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: 11/10/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/14/2023]
Abstract
Generalised pustular psoriasis (GPP) is a rare and severe form of pustular psoriasis. It is defined by persisting or relapsing macroscopically visible sterile primary pustules occurring on non-acral skin and not within psoriasis plaques. Due to its rarity, there is a lack of randomised controlled trials on GPP and its associated gastrointestinal (GI) and liver disorders. In this article, we present a review of the GI and hepatic disorders associated with GPP. GPP is known to be associated with extracutaneous manifestations such as neutrophilic cholangitis. Abnormal liver function tests are reported in up to 90% of patients with GPP upon diagnosis. Less commonly, pancreatitis and gastrointestinal bleeding have been attributed to GPP. While a psoriasis registry with 7.5% prevalence of pustular psoriasis reported an association with viral hepatitis B and C, the true relationship remains to be elucidated as hepatitis B is endemic in Asia where GPP prevalence is higher. Common genetic mutations between GPP and conditions such as hepatocellular carcinoma and inflammatory bowel disease have been identified, explaining their possible associations and providing answers to potential therapeutic options for these conditions. A lack of recognition of these association may result in unnecessary withdrawal of efficacious and definitive drugs for the treatment of GPP. Understanding the characteristics of the associated GI and hepatic disorders will have important implications for targeting the appropriate therapeutics.
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Affiliation(s)
| | - Hazel H Oon
- National Skin Centre, Singapore City, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
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4
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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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5
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Pilania RK, Dawman L, Srinivasan S, Kashif AW, Nada R, Vignesh P, Vinay K, Suri D, Tiewsoh K. Psoriatic Skin Lesions Associated With Subnephrotic Proteinuria in an 8-Year-Old Boy. J Clin Rheumatol 2021; 27:S840-S841. [PMID: 32084074 DOI: 10.1097/rhu.0000000000001347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Rakesh Kumar Pilania
- From the Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre
| | - Lesa Dawman
- Pediatric Nephrology Unit, Department of Pediatrics, Advanced Pediatrics Centre
| | - Santhya Srinivasan
- Pediatric Nephrology Unit, Department of Pediatrics, Advanced Pediatrics Centre
| | | | | | - Pandiarajan Vignesh
- From the Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre
| | - Keshavmurthy Vinay
- Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepti Suri
- From the Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre
| | - Karalanglin Tiewsoh
- Pediatric Nephrology Unit, Department of Pediatrics, Advanced Pediatrics Centre
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6
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Hadeler E, Mosca M, Hong J, Brownstone N, Liao W, Bhutani T, Shinkai K. Inpatient Management of Psoriasis: A Current Perspective and Update for Clinicians. CURRENT DERMATOLOGY REPORTS 2021. [DOI: 10.1007/s13671-021-00342-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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7
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Wang Q, Liu W, Zhang L. Clinical features of von Zumbusch type of generalized pustular psoriasis in children: a retrospective study of 26 patients in southwestern China. An Bras Dermatol 2018; 92:319-322. [PMID: 29186241 PMCID: PMC5514569 DOI: 10.1590/abd1806-4841.20175536] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 05/03/2016] [Indexed: 11/21/2022] Open
Abstract
Background Von Zumbusch type of generalized pustular psoriasis is a rare variant of
psoriasis in children. It can occur in patients with or without psoriasis
vulgaris. Objective The aim of the study was to discuss the precipitating factors, clinical
manifestations, laboratory data and therapy of von Zumbusch type of
generalized pustular psoriasis in children from southwestern China and to
improve the diagnosis and treatment level. Methods A retrospective analysis was conducted for inpatients aged 14 years old or
less with von Zumbusch type of generalized pustular psoriasis in our
department from 2005 to 2014. Results A total of 26 patients were included, of whom four (15.38%) had previous
history of psoriasis vulgaris and one (3.85%) had previous history of
psoriasis arthropathica. Mean onset age was 6.90 years. Gender distribution
was equivalent. Incidence of the disease in summer and autumn was higher
than that in winter and spring. Nineteen (73.08%) cases were triggered by
infection, two (7.69%) cases were caused by sudden discontinuation of
systemic use of corticosteroid. Twenty-four (92.31%) cases had concomitant
fever. The initial lesion manifested as non-follicular sterile pustules on
erythema. Sixteen patients responded well to acitretin, 11 to
Tripterygium wilfordii Hook F (TwHF), two to
cyclosporine, and one to methotrexate. Study limitations This study is a retrospective one and the number of cases is small. CONCLUSION Von Zumbusch type of generalized pustular psoriasis is a rare disease in
children, infection is the most common precipitating factor, acitretin is
the first-line therapy, traditional Chinese medicine TwHF also can be
used.
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Affiliation(s)
- Qian Wang
- The Institute of Dermatology and Venereology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital - Chengdu, China
| | - Wei Liu
- The Institute of Dermatology and Venereology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital - Chengdu, China
| | - Lixia Zhang
- The Institute of Dermatology and Venereology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital - Chengdu, China
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8
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Chen P, Li C, Xue R, Chen H, Tian X, Zeng K, Zhang X, Liang J. Efficacy and safety of acitretin monotherapy in children with pustular psoriasis: results from 15 cases and a literature review. J DERMATOL TREAT 2017; 29:353-363. [PMID: 29098909 DOI: 10.1080/09546634.2017.1395798] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Pingjiao Chen
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, P.R. China
| | - Changxing Li
- Department of Dermatology, Dongguan Sixth People’s Hospital, Dongguan, P.R. China
| | - Rujun Xue
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, P.R. China
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, P.R. China
| | - Huiheng Chen
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, P.R. China
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, P.R. China
| | - Xin Tian
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, P.R. China
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, P.R. China
| | - Kang Zeng
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, P.R. China
| | - Xibao Zhang
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, P.R. China
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, P.R. China
| | - Jingyao Liang
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, P.R. China
- Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, P.R. China
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9
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Kosumi H, Ito T, Fujita Y, Izumi K, Maya Y, Yanagi T, Natsuga K, Ujiie H, Shinkuma S, Nomura T, Sadanobu N, Shimizu H. Generalized Pustular Psoriasis. J Pediatr 2017. [PMID: 28629688 DOI: 10.1016/j.jpeds.2017.05.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Hideyuki Kosumi
- Department of Dermatology Hokkaido University Graduate School of Medicine Sapporo, Japan
| | - Takamasa Ito
- Department of Dermatology Hokkaido University Graduate School of Medicine Sapporo, Japan
| | - Yasuyuki Fujita
- Department of Dermatology Hokkaido University Graduate School of Medicine Sapporo, Japan
| | - Kentaro Izumi
- Department of Dermatology Hokkaido University Graduate School of Medicine Sapporo, Japan
| | - Yuka Maya
- Department of Dermatology Hokkaido University Graduate School of Medicine Sapporo, Japan
| | - Teruki Yanagi
- Department of Dermatology Hokkaido University Graduate School of Medicine Sapporo, Japan
| | - Ken Natsuga
- Department of Dermatology Hokkaido University Graduate School of Medicine Sapporo, Japan
| | - Hideyuki Ujiie
- Department of Dermatology Hokkaido University Graduate School of Medicine Sapporo, Japan
| | - Satoru Shinkuma
- Department of Dermatology Hokkaido University Graduate School of Medicine Sapporo, Japan
| | - Toshifumi Nomura
- Department of Dermatology Hokkaido University Graduate School of Medicine Sapporo, Japan
| | | | - Hiroshi Shimizu
- Department of Dermatology Hokkaido University Graduate School of Medicine Sapporo, Japan
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10
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Posso-De Los Rios CJ, Pope E, Lara-Corrales I. A systematic review of systemic medications for pustular psoriasis in pediatrics. Pediatr Dermatol 2014; 31:430-9. [PMID: 24890463 DOI: 10.1111/pde.12351] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There is lack of information and evidence-based studies on the treatment of pediatric pustular psoriasis. Previous reports have emphasized the limitations of the existing data and encouraged the exploration of therapy optimization through more structured research. The objective of the current study was to perform a systematic review of systemic interventions for pediatric pustular psoriasis with an emphasis on clinical response and treatment outcomes. A systematic literature search was conducted using the PubMed and Embase databases from 1982 to 2012. Of 632 references identified, 14 met our inclusion criteria and were included in the analysis. A cohort of eight patients from the Hospital for Sick Children, Toronto, Canada, was also included. Information was limited to systemic treatments in children. Only English- and Spanish-language articles were included. Information was gathered from 24 patients, 22 of whom (92%) presented with generalized pustular psoriasis and 2 (8%) with acral distribution. The mean age at presentation was 6.3 ± 4.9 years. More than one intervention was required in 12 (50%) cases. The most common therapies used for generalized pustular psoriasis were acitretin, cyclosporine, and methotrexate. We identified that there is lack of information regarding long-term response to systemic drugs because the data were focused on treatment initiation. Treatment of pustular psoriasis in pediatrics is challenging. Although acitretin, methotrexate, and cyclosporine seem to control generalized pustular psoriasis within 3 months of therapy initiation, information on long-term follow-up is lacking. Furthermore, physicians may encounter difficulties after discontinuing or tapering medications.
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Affiliation(s)
- Claudia J Posso-De Los Rios
- Section of Dermatology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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11
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Posso-De Los Rios CJ, Pope E. New insights into pustular dermatoses in pediatric patients. J Am Acad Dermatol 2014; 70:767-773. [DOI: 10.1016/j.jaad.2013.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 10/02/2013] [Accepted: 11/04/2013] [Indexed: 11/29/2022]
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12
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Borges-Costa J, Silva R, Gonçalves L, Filipe P, Soares de Almeida L, Marques Gomes M. Clinical and laboratory features in acute generalized pustular psoriasis: a retrospective study of 34 patients. Am J Clin Dermatol 2011; 12:271-6. [PMID: 21495733 DOI: 10.2165/11586900-000000000-00000] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Acute generalized pustular psoriasis (AGPP) is a rare variant of psoriasis that can be lethal without proper treatment. It can be caused by the withdrawal of corticosteroids and, among its extra-cutaneous manifestations, liver abnormalities are frequently under-reported or attributed to drugs. OBJECTIVE The aim of this study was to assess the clinical and laboratory data, treatment options, and disease outcome in patients with AGPP and to search for significant differences between subgroups of these patients. STUDY DESIGN This was a retrospective analysis of the clinical files from inpatients with AGPP observed in our department between 1973 and 2008. Statistical tests were performed at a significance level of 5%. SETTING This was an inpatient, single-center study. MAIN OUTCOME MEASURES Outcome measures were a previous history of psoriasis, corticosteroid use before admittance, mortality rate, white blood cell count, absolute neutrophil count, and abnormalities in liver enzymes. RESULTS A total of 34 patients fulfilled the inclusion criteria, of whom 61% were men and 65% had a previous history of psoriasis vulgaris. Topical corticosteroids were applied by 50% of patients before admittance. Skin lesions remitted with methotrexate, etretinate, or acitretin treatment in all but two patients who died of sepsis. Abnormalities in liver enzymes were present in 47% of patients. Patients without a previous history of psoriasis had a significantly younger age at the first episode of AGPP. In the comparison between the groups of patients with and without liver abnormalities, a male preponderance and higher leukocyte counts were found in the former, with a positive correlation between the absolute neutrophil count and total bilirubin also being observed. Previous use of retinoids or methotrexate was not associated with these hepatic alterations. LIMITATIONS Limitations of the data were that this was a single-center, retrospective study with a small sample size. CONCLUSIONS Withdrawal of systemic or topical corticosteroids can precipitate or worsen AGPP and these agents should not be used in these patients. Liver abnormalities can be considered an extra-cutaneous manifestation of AGPP. As in other series, no association between the use of drugs and changes in liver tests was found and therefore the deleterious withdrawal of efficient drugs, namely acitretin and methotrexate, should be avoided.
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13
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de Oliveira ST, Maragno L, Arnone M, Fonseca Takahashi MD, Romiti R. Generalized pustular psoriasis in childhood. Pediatr Dermatol 2010; 27:349-54. [PMID: 20403118 DOI: 10.1111/j.1525-1470.2010.01084.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Generalized pustular psoriasis is a rare form of psoriasis consisting of a generalized eruption of sudden onset with erythema and sterile pustules. In children, generalized pustular psoriasis is even more uncommon and may present as a severe and potentially life-threatening disorder. In this study, we present demographics, clinical aspects, treatment response, and follow-up of seven children with generalized pustular psoriasis. Retrospective study reviewing the records of seven children with generalized pustular psoriasis including age, gender, age of onset, presence of scalp and nail involvement, family history, concomitant diseases, precipitating factors, treatment modalities, and outcome. Age of first symptoms ranged from 1 month to 11 years. All patients received systemic retinoids at one time of the follow-up period. Other treatment modalities included immunosuppressive drugs, biologics, phototherapy, and sulfasalazine. Two patients presented with severe constitutional illness, secondary infection and septic shock, including one fatal outcome. All further cases have remained free of recurrences for a mean period of up to 3 years. In our study, generalized pustular psoriasis presented a wide clinical spectrum in children ranging from mild, asymptomatic outbreaks to more severe, life-threatening episodes. One fatality was observed. Children generally responded well to systemic retinoids. Further studies and long-term follow-up periods are needed to define potential trigger factors, efficacy and safety of different treatment modalities in children with generalized pustular psoriasis.
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14
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de Jager ME, de Jong EM, van de Kerkhof PC, Seyger MM. Efficacy and safety of treatments for childhood psoriasis: A systematic literature review. J Am Acad Dermatol 2010; 62:1013-30. [DOI: 10.1016/j.jaad.2009.06.048] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Revised: 06/08/2009] [Accepted: 06/11/2009] [Indexed: 11/30/2022]
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15
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Bagga A, Menon S, Hari P, Mantan M, Dinda A. Nephrotic syndrome preceding psoriasis in children. Pediatr Nephrol 2007; 22:1373-6. [PMID: 17457619 DOI: 10.1007/s00467-007-0487-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2006] [Revised: 03/11/2007] [Accepted: 03/13/2007] [Indexed: 12/01/2022]
Abstract
Nephrotic syndrome is considered to be a late complication of psoriasis, reported usually in adults and characterized by IgA nephropathy or focal segmental glomerulosclerosis. We report on four children in whom steroid-resistant nephrotic syndrome either preceded (n = 3), by 41-120 months, or occurred simultaneously (n = 1) with psoriasis; renal histology showed minimal change disease. Therapy with corticosteroids and cyclosporine resulted in remission of renal and cutaneous symptoms. Minimal change nephrotic syndrome and psoriasis might share similar mechanisms of pathogenesis involving cell-mediated immunity.
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Affiliation(s)
- Arvind Bagga
- Division of Nephrology, Department of Paediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
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16
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Cabanillas M, Pérez-Pérez L, Sánchez-Aguilar D, Toribio J. Psoriasis pustulosa generalizada y hepatitis citolítica asociada a colangitis neutrofílica. ACTAS DERMO-SIFILIOGRAFICAS 2006; 97:330-3. [PMID: 16956566 DOI: 10.1016/s0001-7310(06)73412-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Generalized pustular psoriasis (GPP) of the von Zumbusch type may be associated with liver disorders, usually resulting in cholestatic hepatitis with neutrophilic cholangitis. We describe the case of a woman who experienced a first episode of GPP, during which she presented with an increase in hepatic cytolysis parameters. An abdominal ultrasound and serological studies did not show any significant anomalies. A liver biopsy showed the presence of a neutrophilic infiltrate around the bile ducts of the portal space. In short, this fact suggests that neutrophilic cholangitis in the context of this disease may initially show patterns of analytical alterations other than the classically described cholestatic pattern.
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Affiliation(s)
- Miguel Cabanillas
- Departamento de Dermatología, Complejo Hospitalario Universitario, Facultad de Medicina, Santiago de Compostela, España.
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17
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Lapeyre H, Courville P, François A, Musette P, Le Roy F, Joly P. Vascularite glomérulaire rénale nécrosante à IgA au cours d’un psoriasis pustuleux. Ann Dermatol Venereol 2006; 133:472-3. [PMID: 16760839 DOI: 10.1016/s0151-9638(06)70944-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- H Lapeyre
- Clinique Dermatologique, Hôpital Charles Nicolle, CHU de Rouen
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18
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Cabanillas M, Sánchez-Aguilar D, Pérez-Becerra E, Toribio J. Psoriasis pustulosa generalizada y colangitis neutrofílica. Med Clin (Barc) 2006; 126:557-8. [PMID: 16756914 DOI: 10.1157/13087148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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19
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Viguier M, Allez M, Zagdanski AM, Bertheau P, de Kerviler E, Rybojad M, Morel P, Dubertret L, Lémann M, Bachelez H. High frequency of cholestasis in generalized pustular psoriasis: Evidence for neutrophilic involvement of the biliary tract. Hepatology 2004; 40:452-8. [PMID: 15368450 DOI: 10.1002/hep.20305] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Generalized pustular psoriasis is a rare form of psoriasis that is sometimes associated with extracutaneous manifestations. Evidence for biliary involvement has been suggested in isolated cases. We investigated the prevalence and nature of liver abnormalities occurring in this disease. Twenty-two patients consecutively admitted for generalized pustular psoriasis who underwent liver biological tests at the time of the attack and during the following weeks were included. Twenty patients (90%) had at least one abnormal biological liver parameter. Eleven patients (50%) had pronounced abnormalities: jaundice (4/22), gammaglutamyl transferase higher than 5 times the normal value (10/22), alkaline phosphatase higher than twice the normal value (7/22), and/or aminotransferases higher than 3 times the normal value (7/22). These abnormalities returned to normal range at the time of remission of pustular psoriasis, suggesting that severe liver abnormalities could be associated with severe cutaneous disease. Neutrophilic cholangitis was observed on liver biopsy. Persistent magnetic resonance cholangiopancreatography features similar to those observed in sclerosing cholangitis were found in 3 of the 4 patients studied. No causal factor other than pustular psoriasis could be identified. In conclusion, our results demonstrate the high frequency of liver abnormalities in patients with generalized pustular psoriasis. Biliary involvement related to neutrophilic cholangitis should be added to the spectrum of extracutaneous manifestations of this disease, and physicians should be aware of such a complication.
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Affiliation(s)
- Manuelle Viguier
- Department of Dermatology 1, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris and Université Paris 7, Paris, France.
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Zappel K, Sterry W, Blume-Peytavi U. Therapieoptionen der Psoriasis im Kindes- und Jugendalter. Therapy options for psoriasis in childhood and adolescence. J Dtsch Dermatol Ges 2004; 2:329-42. [PMID: 16281521 DOI: 10.1046/j.1439-0353.2004.04061.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Up to 30% of all psoriatic patients show their first symptoms during childhood and adolescence. In 1/4 of these children, psoriatic lesions appear within the first two years of life. The treatment of pediatric psoriasis differs considerably in several ways from that of adults. Not only the age and intensity but also physical development, prognostic criteria and social background should be considered. Standard procedures, clinical trials of high quality and therapeutic guidelines for psoriasis in childhood are still lacking. This review surveys the therapeutic management of pediatric and juvenile psoriasis. Current topical and systemic therapy options are critically reviewed. Prevention as well as enhancement of quality of life are also considered.
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Affiliation(s)
- Kristina Zappel
- Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin, Charité Campus Mitte.
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21
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Abstract
Psoriasis commences by the age of 15 years in one third of patients and is an important childhood disorder. Various human leukocyte antigen associations are important in predisposition to psoriasis, and streptococcal disease is important in its precipitation and exacerbation. The disorder takes many clinical forms, with guttate lesions and anogenital and facial involvement being particularly prominent in the childhood age group. Pustular psoriasis and psoriatic arthropathy are rare in this group of patients. It is important to take the age of the patient into account when making treatment choices.
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Affiliation(s)
- Maureen Rogers
- Department of Dermatology, Children's Hospital at Westmead, Sydney, Australia.
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Sharkey MP, Muir JB. Staphylococcal scalded skin syndrome complicating acute generalized pustular psoriasis. Australas J Dermatol 2002; 43:199-201. [PMID: 12121398 DOI: 10.1046/j.1440-0960.2002.00595.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 60-year-old woman with psoriasis vulgaris treated with oral cyclosporin and acitretin developed an acute generalized pustular eruption with erythema and associated fever consistent with acute generalized pustular psoriasis. She was admitted to hospital and, despite intravenous fluid replacement, developed acute renal failure. In addition, she developed staphylococcal septicaemia. After transfer to the intensive care unit because of deteriorating renal function, a sudden onset of widespread flaccid blistering (Nikolsky sign positive) and superficial erosions was noted. Histology of a biopsied blister revealed subcorneal splitting of the epidermis consistent with staphylococcal scalded skin syndrome. The patient was treated with intravenous dicloxacillin and the blistering gradually improved over 10 days.
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Affiliation(s)
- Michael P Sharkey
- Dermatology Department, Mater Misericordiae Hospital, South Brisbane, Queensland, Australia
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