1
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Yamashita T, Shimizuhira C, Hiwa R, Fukuoka M. A case of generalized pustular psoriasis following discontinuation of apremilast. J Dermatol 2024. [PMID: 38831640 DOI: 10.1111/1346-8138.17314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 06/05/2024]
Affiliation(s)
| | | | - Ryosuke Hiwa
- Department of General Medicine, Rakuwakai Otowa Hospital, Kyoto, Japan
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Miyuki Fukuoka
- Department of Dermatology, Rakuwakai Otowa Hospital, Kyoto, Japan
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2
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Teshima R, Saito-Sasaki N, Hitaka T, Sawada Y. Spesolimab in the Management of Generalized Pustular Psoriasis With Concurrent Bullous Pemphigoid and Psoriasis. Cureus 2024; 16:e60331. [PMID: 38883056 PMCID: PMC11177237 DOI: 10.7759/cureus.60331] [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: 05/14/2024] [Indexed: 06/18/2024] Open
Abstract
Autoimmune diseases often co-occur due to shared immunological mechanisms, necessitating strategic treatment approaches to manage overlapping conditions without exacerbating each other. A 75-year-old male with a history of psoriasis vulgaris and bullous pemphigoid (BP) developed new-onset pustular psoriasis under systemic corticosteroid therapy, which is known to potentially worsen psoriasis into its pustular form. Histological examination confirmed the diagnosis, showing features typical of pustular psoriasis. The patient was successfully treated with spesolimab, an anti-IL-36 neutralizing antibody, achieving complete remission without aggravating the BP. This case highlights the necessity of cautious treatment selection in patients with multiple autoimmune disorders and underscores the potential role of IL-36 in exacerbating inflammatory responses in BP. Further research into the interaction between IL-36 and BP may provide deeper insights into managing such complex clinical scenarios.
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Affiliation(s)
- Romane Teshima
- Dermatology, University of Occupational and Environmental Health, Kitakyushu, JPN
| | - Natsuko Saito-Sasaki
- Dermatology, University of Occupational and Environmental Health, Kitakyushu, JPN
| | - Taiyo Hitaka
- Dermatology, University of Occupational and Environmental Health, Kitakyushu, JPN
| | - Yu Sawada
- Dermatology, University of Occupational and Environmental Health, Kitakyushu, JPN
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3
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Kodali N, Blanchard I, Kunamneni S, Lebwohl MG. Current management of generalized pustular psoriasis. Exp Dermatol 2023; 32:1204-1218. [PMID: 36779681 DOI: 10.1111/exd.14765] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/06/2023] [Accepted: 02/08/2023] [Indexed: 02/14/2023]
Abstract
Generalized pustular psoriasis (GPP) is a rare subset of psoriasis involving episodes of sterile pustules accompanied by inflammation and, often, systemic involvement. The inflammatory nature of GPP has potential for severe multisystem complications including high-output cardiac failure, infections, digestive system issues, and disfiguring or lethal acute flare episodes. The disease tends to have higher prevalence in females and Asians. The IL-1/IL-36 inflammatory pathway is a critical facet of GPP's pathology. Genetic mutations that are associated with GPP include modifications of Interleukin 36 Receptor Antagonist (IL36RN), Caspase Recruitment Domain Family Member 14 (CARD14), Adaptor Related Protein Complex 1 Subunit Sigma 3 (AP1S3), Myeloperoxidase (MPO) and Serpin Peptidase Inhibitor Clade A Member 3 (SERPINA3) genes. Treatment guidelines for GPP are not well-entrenched. Currently, only one GPP-specific treatment, the interleukin-36 receptor antagonist (IL-36Ra) spesolimab, has been approved for use in the United States. Additional anti-IL-36 pathway therapies are currently being developed. Other treatment options include other biologic therapies such as IL-17 inhibitors, IL-23 inhibitors and TNFα inhibitors. Non-biologic therapeutic options include retinoids, cyclosporine and methotrexate. Treatment options differ throughout the world; most countries utilize retinoids, cyclosporine and methotrexate as first-line non-biologic options. China and United Kingdom have no GPP-specific biologic therapies approved for use, while several biologic therapies are approved for use in Japan. This review aims to serve as an update on the current global management of GPP while also including relevant aspects of disease pathogenesis, diagnosis, clinical presentation, histopathology, aetiology and epidemiology.
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Affiliation(s)
- Nilesh Kodali
- Department of Education, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Isabella Blanchard
- Department of Education, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Sruthi Kunamneni
- Department of Education, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Mark G Lebwohl
- Dermatology, The Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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4
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Costanzo A, Bardazzi F, DE Simone C, Fabbrocini G, Foti C, Marzano AV, Naldi L, Parodi A, Prignano F, Girolomoni G. Pustular psoriasis with a focus on generalized pustular psoriasis: classification and diagnostic criteria. An Italian expert consensus. Ital J Dermatol Venerol 2022; 157:489-496. [PMID: 36651202 DOI: 10.23736/s2784-8671.22.07415-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Generalized pustular psoriasis (GPP) is a severe and life-threatening systemic disease associated with significant morbidity and mortality. Recent progress has been made in understanding the pathogenetic pathways involved in GPP and an intricate interaction between innate and adaptive immune mechanisms has been suggested. Despite formal consensus guidelines on pustular psoriasis currently available in the literature, the definitions and classifications of GPP used across studies were inconsistent. Consequently, there are no unified criteria that can be universally adopted for precise diagnosis, classification and effective treatment of GPP patients with new targeted drugs. The aim of this review was to collect all the main evidence on available diagnostic criteria for GPP and to establish recommendations in order to promote a better stratification and therapeutic management of this severe and heterogeneous disease.
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Affiliation(s)
- Antonio Costanzo
- Unit of Dermatology, Department of Biomedical Sciences, Humanitas University, Milan, Italy - .,Skin Pathology Laboratory, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy -
| | - Federico Bardazzi
- Department of Dermatology, IRCCS S. Orsola-Malpighi Polyclinic, Bologna, Italy.,Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Clara DE Simone
- Section of Dermatology, Sacred Heart Catholic University, Rome, Italy.,Department of Dermatology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology and Venereology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Caterina Foti
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Angelo V Marzano
- Unit of Dermatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Luigi Naldi
- Department of Dermatology, AULSS8 - San Bortolo Hospital, Vicenza, Italy
| | - Aurora Parodi
- DiSSal Sezione Dermatologia, IRCCS San Martino Polyclinic Hospital, University of Genoa, Genoa, Italy
| | - Francesca Prignano
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giampiero Girolomoni
- Section of Dermatology, Department of Medicine, University of Verona, Verona, Italy
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5
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Vincken NLA, Balak DMW, Knulst AC, Welsing PMJ, van Laar JM. Systemic glucocorticoid use and the occurrence of flares in psoriatic arthritis and psoriasis: a systematic review. Rheumatology (Oxford) 2022; 61:4232-4244. [PMID: 35285486 PMCID: PMC9629346 DOI: 10.1093/rheumatology/keac129] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/03/2022] [Accepted: 02/20/2022] [Indexed: 01/19/2023] Open
Abstract
Objectives The use of systemic glucocorticoids (SGCs) is traditionally discouraged in the treatment of PsA and psoriasis due to the risk of psoriatic flares. However, despite this recommendation, SGCs are frequently prescribed for these patients. In this study we reappraise the old paradigm that SGCs are contra-indicated in the treatment of PsA and psoriasis. Methods A systematic search of MEDLINE, EMBASE and the Cochrane Library databases was performed in November 2019 to identify articles on any SGC use compared with no use in the PsA and psoriasis population. Topical glucocorticoid treatment was excluded. Our two primary outcomes focused on the prescribing characteristics and the occurrence of any type of flare. Results Our search yielded 4922 articles, and of these 21 full-text articles were eligible for inclusion. There were 11 retro- and prospective cohorts involving a total of 4,171,307 patients. Of these, 6727 (37.82%) of the patients with PsA and 1 460 793 (35.17%) of the patients with psoriasis were treated with any type of SGC. Ten observational/interventional studies did not report an increased risk or occurrence of psoriatic flares related to SGC use. Conclusion Our results indicate that SGCs are frequently prescribed for PsA and psoriasis patients. The occurrence of psoriatic flares appears to be low upon SGC exposure. In patients with a clear indication for SGCs, e.g. in need of rapid anti-inflammatory therapy or bridging of therapies, the use of SGCs should be considered in view of the low risk of skin flaring. It remains of importance to weigh risks for short- and long-term SGC-related side effects in clinical decision making.
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Affiliation(s)
- Nanette L A Vincken
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Deepak M W Balak
- Department of Dermatology, LangeLand Ziekenhuis, Zoetermeer, The Netherlands
| | - André C Knulst
- Department of Dermatology & Allergology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Paco M J Welsing
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jacob M van Laar
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
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6
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Romiti R, Hirayama ALDS, Arnone M, Magalhães RF. Generalized pustular psoriasis (von Zumbusch). An Bras Dermatol 2021; 97:63-74. [PMID: 34838431 PMCID: PMC8799844 DOI: 10.1016/j.abd.2021.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/03/2021] [Accepted: 05/04/2021] [Indexed: 11/19/2022] Open
Abstract
Generalized pustular psoriasis (von Zumbusch) is a rare and acute eruption characterized by multiple sterile pustules over an erythematous and edematous background, eventually associated with psoriasis vulgaris. Classically, it manifests as a potentially severe systemic picture and demands prompt diagnosis and intervention. The duration of each flare-up and intervals between the pustular episodes is extremely variable. Recently, genetic abnormalities have been identified mainly in the familial and early variants of this disease. The therapeutic arsenal is limited; however, new drugs being evaluated aim to control both pustular flare-ups and disease recurrences.
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Affiliation(s)
- Ricardo Romiti
- Department of Dermatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - André Luís da Silva Hirayama
- Department of Dermatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Marcelo Arnone
- Department of Dermatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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7
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El Jazouly M, Alj M, Chahboun F, Al Bouzidi A, Chiheb S. Generalized annular pustular psoriasis (Milian-Katchoura type) induced by systemic steroids. Clin Case Rep 2021; 9:2507-2509. [PMID: 33936734 PMCID: PMC8077317 DOI: 10.1002/ccr3.4063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/22/2021] [Accepted: 03/01/2021] [Indexed: 11/09/2022] Open
Abstract
The aim of my clinical image is to recall this rare and benign form of pustular psoriasis and to insist on the role of the triggers of pustular psoriasis, mainly the drugs.
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Affiliation(s)
- Madiha El Jazouly
- Department of DermatologyCheikh Khalifa International HospitalUniversity Mohamed IV of Health SciencesCasablancaMorocco
| | - Maha Alj
- Department of DermatologyCheikh Khalifa International HospitalUniversity Mohamed IV of Health SciencesCasablancaMorocco
| | - Fatimzahra Chahboun
- Department of DermatologyCheikh Khalifa International HospitalUniversity Mohamed IV of Health SciencesCasablancaMorocco
| | - Abderrahman Al Bouzidi
- Department of PathologyCheikh Khalifa International HospitalUniversity Mohamed IV of Health SciencesCasablancaMorocco
| | - Soumiya Chiheb
- Department of DermatologyCheikh Khalifa International HospitalUniversity Mohamed IV of Health SciencesCasablancaMorocco
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8
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Schwarz CW, Loft N, Andersen V, Juul L, Zachariae C, Skov L. Are Systemic Corticosteroids Causing Psoriasis Flare-Ups? Questionnaire for Danish Dermatologists, Gastroenterologists and Rheumatologists. Dermatology 2020; 237:588-594. [PMID: 33049749 DOI: 10.1159/000510712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 08/06/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Psoriasis flare-ups and the change of morphology from nonpustular to pustular psoriasis following tapering and withdrawal of systemic corticosteroids have been reported. Despite these risks, systemic corticosteroids are still widely prescribed for patients with psoriasis, but the knowledge about psoriasis flare-ups and whether the physicians take precautions during these treatments is limited. METHODS We conducted a questionnaire study among all dermatologists, gastroenterologists and rheumatologists in Denmark who work at a hospital or in a private practice to investigate the use, opinion and experience with oral, intramuscular and intra-articular corticosteroids in the treatment of patients with psoriasis. RESULTS We received answers from a total of 248 physicians. Compared with oral and intramuscular corticosteroids, intra-articular corticosteroids were the most reported treatment in patients with psoriasis and only used by the rheumatologists. It was mainly the dermatologists and rheumatologists who had observed psoriasis flare-ups following treatment with oral, intramuscular and intra-articular corticosteroids. Half of the dermatologists (50%) and a fourth of the rheumatologists (29%) had observed at least one psoriasis flare-up following treatment with oral corticosteroids. About 10% of both the dermatologists and the rheumatologists had observed at least one psoriasis flare-up following treatment with intramuscular and/or intra-articular corticosteroids. Overall, 44% of the respondents took precautions, when they treated a patient with psoriasis with oral, intramuscular and intra-articular corticosteroids. CONCLUSION The results from the questionnaire indicate that systemic corticosteroids for patients with psoriasis can cause flare-ups and should be used with care.
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Affiliation(s)
- Christopher Willy Schwarz
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Copenhagen Research Group for Inflammatory Skin, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Nikolai Loft
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark, .,Copenhagen Research Group for Inflammatory Skin, Herlev and Gentofte Hospital, Hellerup, Denmark,
| | - Vibeke Andersen
- Focused Research Unit for Molecular Diagnostic and Clinical Research, IRS Center Sonderjylland, Hospital of Southern Jutland, Aabenraa, Denmark.,Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Lars Juul
- Department of Rheumatology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Claus Zachariae
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Copenhagen Research Group for Inflammatory Skin, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Lone Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Copenhagen Research Group for Inflammatory Skin, Herlev and Gentofte Hospital, Hellerup, Denmark
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9
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Ly K, Beck KM, Smith MP, Thibodeaux Q, Bhutani T. Diagnosis and screening of patients with generalized pustular psoriasis. PSORIASIS-TARGETS AND THERAPY 2019; 9:37-42. [PMID: 31417859 PMCID: PMC6592018 DOI: 10.2147/ptt.s181808] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 06/01/2019] [Indexed: 12/21/2022]
Abstract
Generalized pustular psoriasis (GPP) is a rare and potentially life-threatening variant of psoriasis that is characterized by recurrent, acute onset, widely distributed pustular eruptions on inflamed, erythematous skin. It is important to recognize acute GPP as a subtype of psoriasis associated with high morbidity and mortality so therapy can be initiated without delay. Since GPP was first described in 1910 by Leopold von Zumbusch, it has been inconsistently defined, stratified, and diagnosed in the literature. Multiple definitions and diagnostic criteria have been proposed over the years. Recently, formal consensus guidelines on GPP have been published by international groups. This article reviews the current evidence and understanding in the diagnosis and screening of GPP.
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Affiliation(s)
- Karen Ly
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Kristen M Beck
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Mary P Smith
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Quinn Thibodeaux
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Tina Bhutani
- Department of Dermatology, University of California, San Francisco, CA, USA
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10
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Tejeda CI, Voss V, Salvemini JN. Known history of pustular psoriasis with reactivation from in vitro fertilization therapy. JAAD Case Rep 2019; 5:543-545. [PMID: 31206001 PMCID: PMC6558305 DOI: 10.1016/j.jdcr.2019.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Christina I. Tejeda
- Columbia Vagelos College of Physicians and Surgeons, New York, New York
- Correspondence to: Christina I. Tejeda, BS, 100 Haven Avenue Apt. 6B, New York, NY 10032.
| | - Vanessa Voss
- Department of Dermatology, Stony Brook University Hospital, Stony Brook, New York
| | - Joann N. Salvemini
- Department of Dermatology, Stony Brook University Hospital, Stony Brook, New York
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11
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Peccerillo F, Odorici G, Ciardo S, Conti A, Pellacani G. Evaluation of generalized pustular psoriasis by reflectance confocal microscopy. Skin Res Technol 2019; 25:402-403. [DOI: 10.1111/srt.12655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 10/27/2018] [Accepted: 12/09/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Francesca Peccerillo
- Department of SurgicalMedical, Dental and Morphological Sciences with Interest Transplant, Oncological and Regenerative Medicine Modena Italy
- Dermatology UnitUniversity of Modena and Reggio Emilia Modena Italy
| | - Giulia Odorici
- Department of SurgicalMedical, Dental and Morphological Sciences with Interest Transplant, Oncological and Regenerative Medicine Modena Italy
- Dermatology UnitUniversity of Modena and Reggio Emilia Modena Italy
| | - Silvana Ciardo
- Department of SurgicalMedical, Dental and Morphological Sciences with Interest Transplant, Oncological and Regenerative Medicine Modena Italy
- Dermatology UnitUniversity of Modena and Reggio Emilia Modena Italy
| | - Andrea Conti
- Department of SurgicalMedical, Dental and Morphological Sciences with Interest Transplant, Oncological and Regenerative Medicine Modena Italy
- Dermatology UnitUniversity of Modena and Reggio Emilia Modena Italy
| | - Giovanni Pellacani
- Department of SurgicalMedical, Dental and Morphological Sciences with Interest Transplant, Oncological and Regenerative Medicine Modena Italy
- Dermatology UnitUniversity of Modena and Reggio Emilia Modena Italy
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12
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Vyas NS, Charifa A, Desman GT, McNiff JM. Distinguishing pustular psoriasis and acute generalized exanthematous pustulosis on the basis of plasmacytoid dendritic cells and MxA protein. J Cutan Pathol 2019; 46:317-326. [PMID: 30667074 DOI: 10.1111/cup.13430] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 12/19/2018] [Accepted: 01/14/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Distinguishing acute generalized exanthematous pustulosis (AGEP) and pustular psoriasis (PS) can be challenging. Staining for plasmacytoid dendritic cells, or PDCs (producer of IFN-α/β), and MxA (an IFN-α/β inducible protein) may help discriminate these entities. METHODS Forty-three cases of AGEP and PS were compiled from two academic institutions. All cases were examined for CD123+ PDCs, eosinophils, acanthosis, papillomatosis, suprapapillary plate thinning, tortuous dilated capillaries, single necrotic keratinocytes, papillary dermal edema, vasculitis, eosinophil exocytosis, intraepidermal pustules, and subcorneal pustules. A subset of cases (n = 26) was stained for MxA. RESULTS Perivascular and intraepidermal PDCs, dilated tortuous vessels, and MxA expression in the dermal inflammatory infiltrate were significantly (P < 0.05) in favor of a diagnosis of PS. The absence of PDCs and presence of eosinophils favored a diagnosis of AGEP (P < 0.05). CONCLUSIONS We found compelling evidence for the use of CD123 to highlight PDCs in these cases. The presence of PDCs and expression of MxA in dermal inflammatory infiltrate, as well as absence of eosinophils and presence of tortuous dilated capillaries favored a diagnosis of PS. Expression of MxA in the dermal infiltrate corresponds with a Th1 pathway in PS and may indicate a Th1 component in the early initial phase of AGEP.
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Affiliation(s)
- Nikki S Vyas
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ahmad Charifa
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Garrett T Desman
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jennifer M McNiff
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
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13
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Boehner A, Navarini AA, Eyerich K. Generalized pustular psoriasis - a model disease for specific targeted immunotherapy, systematic review. Exp Dermatol 2018; 27:1067-1077. [DOI: 10.1111/exd.13699] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Alexander Boehner
- Department of Dermatology and Allergy Biederstein; Technical University of Munich; Munich Germany
| | | | - Kilian Eyerich
- Department of Dermatology and Allergy Biederstein; Technical University of Munich; Munich Germany
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14
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Zhou LL, Georgakopoulos JR, Ighani A, Yeung J. Systemic Monotherapy Treatments for Generalized Pustular Psoriasis: A Systematic Review. J Cutan Med Surg 2018; 22:591-601. [DOI: 10.1177/1203475418773358] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Generalized pustular psoriasis (GPP) is a rare but serious and difficult to treat cutaneous disease, with high morbidity and mortality rates. Despite the numerous treatment regimens available, the overall quality of evidence-based research is limited with a lack of an algorithmic approach available. In this review, we aim to evaluate the current level of evidence regarding the efficacy and safety/tolerability of systemic monotherapies available in the treatment of GPP. A comprehensive MEDLINE, EMBASE, and PubMed search of clinical studies examining systemic monotherapy treatment options for GPP was conducted. In total, 31 studies met eligibility criteria. Described treatment modalities included retinoids, cyclosporine, biologics, and dapsone. Despite the lack of high-quality evidence or a well-accepted treatment algorithm for GPP, systemic retinoids, cyclosporine, biologics, and dapsone are all possible first-line agents, with retinoids being one of the best-supported treatment options and biologics as an emerging therapeutic field with great potential requiring additional data. However, the final choice of treatment should be considered within the unique context of each patient.
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Affiliation(s)
| | | | - Arvin Ighani
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jensen Yeung
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Women’s College Hospital, Toronto, ON, Canada
- Probity Medical Research Inc., Waterloo, ON, Canada
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