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Kiszewski AE, De Almeida HL. Successful treatment with ustekinumab in CARD14-associated papulosquamous eruption in a Brazilian child. Dermatol Ther 2022; 35:e15939. [PMID: 36239488 DOI: 10.1111/dth.15939] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/14/2022] [Accepted: 10/12/2022] [Indexed: 01/02/2023]
Abstract
CARD14-associated papulosquamous eruption (CAPE) was proposed in 2018 to describe the clinical features of psoriasis and pityriasis rubra pilaris with CARD 14 mutations. We report a 5-month-old female infant who developed CAPE-associated erythroderma. Although she did not respond to conventional therapies, she responded well to ustekinumab treatment at the age of 4 years.
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Affiliation(s)
- Ana Elisa Kiszewski
- Dermatology Service, Departamento de Clinica Medica, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
- Section of Pediatric Dermatology, Hospital da Criança Santo Antonio, ISCMPA, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | - Hiram Larangeira De Almeida
- Medicine School, Federal University of Pelotas, Pelotas, Brazil
- Medicine School, Catholic University of Pelotas, Pelotas, Brazil
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2
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Katharina M, Sylvia S, Matthias B, Ulrich M, Martin L. Successful treatment of a child's pityriasis rubra pilaris (PRP) with ustekinumab and acitretin. Pediatr Dermatol 2022; 39:659-661. [PMID: 35859269 PMCID: PMC9541132 DOI: 10.1111/pde.14994] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/25/2022] [Accepted: 03/19/2022] [Indexed: 11/26/2022]
Abstract
Pityriasis rubra pilaris (PRP) is a rare inflammatory skin disease that occurs with phenotypic variability in adults of all ages as well as in children. Data on the treatment of PRP is limited. Here, we report a 5-year-old girl with widespread skin involvement and prominent palmoplantar hyperkeratosis who was initially treated for psoriasis. After reevaluation, a diagnosis of PRP was made, and the patient had an excellent therapeutic response to ustekinumab and acitretin.
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Affiliation(s)
- Medek Katharina
- Department of DermatologyUniversity Hospital of the Paracelsus Medical University SalzburgSalzburgAustria
| | - Selhofer Sylvia
- Department of DermatologyUniversity Hospital of the Paracelsus Medical University SalzburgSalzburgAustria
| | - Buchner Matthias
- Department of PediatricsUniversity Hospital of the Paracelsus Medical University SalzburgSalzburgAustria
| | - Mrowietz Ulrich
- Psoriasis‐Center at the Department of DermatologyUniversity Medical Center Schleswig‐HolsteinKielGermany
| | - Laimer Martin
- Department of DermatologyUniversity Hospital of the Paracelsus Medical University SalzburgSalzburgAustria
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Frare CP, Blumstein AJ, Paller AS, Pieretti L, Choate KA, Bowcock AM, Larralde M. CARD14-associated papulosquamous eruption (CAPE) in pediatric patients: Three additional cases and review of the literature. Pediatr Dermatol 2021; 38:1237-1242. [PMID: 34448248 PMCID: PMC8578307 DOI: 10.1111/pde.14779] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
CARD14-associated papulosquamous eruption (CAPE) is a proposed term that encompasses features ranging from psoriasis to pityriasis rubra pilaris (PRP) in association with CARD14 mutations. The early onset of the disease, prominent facial involvement, family history of an autosomal dominant trait, and poor response to conventional treatment are characteristics of CAPE that distinguish it from classical psoriasis and PRP. We describe the clinical features, family history, and response to therapy in three unrelated children with CAPE and compare these characteristics with those of previously described pediatric patients. Testing for CARD14 mutations in children with early onset of features of psoriasis or pityriasis rubra pilaris and resistance to conventional therapy should be considered.
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Affiliation(s)
- Cindy P Frare
- Department of Dermatology, Hospital Alemán, Buenos Aires, Argentina
| | - Alli J Blumstein
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lia Pieretti
- Dr Úraga Private Center for Skin Diseases, Guayaquil, Ecuador
| | - Keith A Choate
- Department of Genetics, Yale University School of Medicine, New Haven, CT, USA
| | - Anne M Bowcock
- Dermatology, Oncological Sciences and Genetics & Genomics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Margarita Larralde
- Department of Dermatology, Hospital Alemán, Buenos Aires, Argentina.,Department of Pediatric Dermatology, Ramos Mejía Hospital, Buenos Aires, Argentina
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Signa S, Campione E, Rusmini M, Chiesa S, Grossi A, Omenetti A, Caorsi R, Viglizzo GM, Galluzzo M, Bianchi L, Talamonti M, Orlandi A, Martini A, Ceccherini I, Gattorno M. Whole exome sequencing approach to childhood onset familial erythrodermic psoriasis unravels a novel mutation of CARD14 requiring unusual high doses of ustekinumab. Pediatr Rheumatol Online J 2019; 17:38. [PMID: 31286971 PMCID: PMC6615224 DOI: 10.1186/s12969-019-0336-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/05/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Autosomal dominant gain of function mutations in caspase recruitment domain family member 14 (CARD14) is a rare condition associated with plaque-type psoriasis, generalized pustular psoriasis, palmoplantar pustular psoriasis and pityriasis rubra pilaris. Recently, a new CARD14 -associated phenotype defined as CAPE (CARD14-associated papulosquamous eruption) with clinical features of both psoriasis and pityriasis rubra pilaris was reported. We describe a family carrying a novel heterozygous mutation in CARD14 gene, with childhood-onset erythrodermic psoriasis requiring an unusual extremely high dose (up to 2 mg/kg every 8 weeks) of ustekinumab to achieve disease remission. CASE PRESENTATION We describe a large family with three pairs of twins presenting a clinical phenotype characterized by childhood-onset erythrodermic psoriasis; in some family members is also reported psoriatic arthritis. The two probands presented poor clinical response to topic and systemic therapy with antihistamine, steroid, retinoids, cyclosporine and etanercept. After exclusion of the most common genes associated to autoinflammatory diseases (IL36RN, IL1RN, MVK, TNFRSF1A, NLRP3, NLRP12, MEFV, NOD2, PSMB8, PSTPIP1, LPIN2) we approached a new gene search by subjecting to Whole Exome Sequencing (WES) analysis five members of the family. A novel heterozygous mutation (c.446 T > G, leading to the missense amino acid substitution p.L149R) in the exon 4 of the CARD14 gene was identified in all affected members. Increasing dosages (up to 2 mg/kg every 8 weeks) of ustekinumab, a human monoclonal antibody targeting interleukin-12 (IL-12) and interleukin-23 (IL-23), allowed the complete control of the clinical manifestations, with an evident reduction of circulating Th17 and Th22 CD4+ T cell subsets. CONCLUSIONS We describe the association of mutations of the CARD14 gene with an erythrodermic psoriasis pedigree, underlying the necessity to investigate CARD14 mutations in childhood-onset psoriasis cases and confirming the presence of CARD14 causative mutations also in erythrodermic psoriasis form, as recently reported. Also in pediatric age, ustekinumab represents a powerful therapeutic option for this rare condition, that is usually refractory to other treatments. In young children, high and frequent dosages allowed a complete control of the clinical manifestations without any severe side effects, with a long-term follow-up.
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Affiliation(s)
- S. Signa
- Centro Malattie Autoinfiammatorie e Immunodeficienze- Clinica Pediatrica e Reumatologia, IRCCS Giannina Gaslini, Via Gaslini 5, 16147 Genova, Italy ,0000 0001 2151 3065grid.5606.5Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Università di Genova, Genoa, Italy
| | - E. Campione
- 0000 0001 2300 0941grid.6530.0Dermatology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - M. Rusmini
- 0000 0004 1760 0109grid.419504.dUO Genetica Medica, IRCCS G. Gaslini, Genoa, Italy
| | - S. Chiesa
- Centro Malattie Autoinfiammatorie e Immunodeficienze- Clinica Pediatrica e Reumatologia, IRCCS Giannina Gaslini, Via Gaslini 5, 16147 Genova, Italy
| | - A. Grossi
- 0000 0004 1760 0109grid.419504.dUO Genetica Medica, IRCCS G. Gaslini, Genoa, Italy
| | - A. Omenetti
- Centro Malattie Autoinfiammatorie e Immunodeficienze- Clinica Pediatrica e Reumatologia, IRCCS Giannina Gaslini, Via Gaslini 5, 16147 Genova, Italy
| | - R. Caorsi
- Centro Malattie Autoinfiammatorie e Immunodeficienze- Clinica Pediatrica e Reumatologia, IRCCS Giannina Gaslini, Via Gaslini 5, 16147 Genova, Italy
| | - G. M. Viglizzo
- 0000 0004 1760 0109grid.419504.dUO Dermatologia , IRCCS G. Gaslini, Genoa, Italy
| | - M. Galluzzo
- 0000 0001 2300 0941grid.6530.0Dermatology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - L. Bianchi
- 0000 0001 2300 0941grid.6530.0Dermatology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - M. Talamonti
- 0000 0001 2300 0941grid.6530.0Dermatology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - A. Orlandi
- 0000 0001 2300 0941grid.6530.0Cattedra di Anatomia Patologica, Policlinico Universitario di Roma “Tor Vergata”, Rome, Italy
| | - A. Martini
- 0000 0004 1760 0109grid.419504.dDirezione Scientifica, IRCCS G. Gaslini, Genoa, Italy
| | - I. Ceccherini
- 0000 0004 1760 0109grid.419504.dUO Genetica Medica, IRCCS G. Gaslini, Genoa, Italy
| | - M. Gattorno
- Centro Malattie Autoinfiammatorie e Immunodeficienze- Clinica Pediatrica e Reumatologia, IRCCS Giannina Gaslini, Via Gaslini 5, 16147 Genova, Italy
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Bonomo L, Raja A, Tan K, Guttman-Yassky E. Successful treatment of juvenile pityriasis rubra pilaris with ustekinumab in a 7-year-old girl. JAAD Case Rep 2018; 4:206-210. [PMID: 29892668 PMCID: PMC5993550 DOI: 10.1016/j.jdcr.2017.09.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Lauren Bonomo
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Aishwarya Raja
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kathryn Tan
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York.,Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York
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Fortina AB, Bardazzi F, Berti S, Carnevale C, Di Lernia V, El Hachem M, Neri I, Gelmetti CM, Lora V, Mazzatenta C, Milioto M, Moretta G, Patrizi A, Peris K, Villani A. Treatment of severe psoriasis in children: recommendations of an Italian expert group. Eur J Pediatr 2017; 176:1339-1354. [PMID: 28836064 DOI: 10.1007/s00431-017-2985-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/28/2017] [Accepted: 08/03/2017] [Indexed: 02/01/2023]
Abstract
UNLABELLED This article provides comprehensive recommendations for the systemic treatment of severe pediatric psoriasis based on evidence obtained from a systematic review of the literature and the consensus opinion of expert dermatologists and pediatricians. For each systemic treatment, the grade of recommendation (A, B, C) based on the treatment's approval by the European Medicines Agency for childhood psoriasis and the experts' opinions is discussed. The grade of recommendation for narrow-band-ultraviolet B phototherapy, cyclosporine, and retinoids is C, while that for methotrexate is C/B. The use of adalimumab, etanercept, and ustekinumab has a grade A recommendation. No conventional systemic treatments are approved for pediatric psoriasis. Adalimumab is approved by the European Medicines Agency as a first-line treatment for severe chronic plaque psoriasis in children (≥ 4 years old) and adolescents. Etanercept and ustekinumab are approved as second-line therapy in children ≥ 6 and ≥ 12 years, respectively. CONCLUSION A treatment algorithm as well as practical tools (i.e., tabular summaries of differential diagnoses, treatment mechanism of actions, dosing regimens, control parameters) are provided to assist in therapeutic reasoning and decision-making for individual patients. These treatment recommendations are endorsed by major Italian Pediatric and Dermatology Societies. What is Known: • Guidelines for the treatment of severe pediatric psoriasis are lacking and most traditional systemic treatments are not approved for use in young patients. Although there has been decades of experience with some of the traditional agents such as phototherapy, acitretin, and cyclosporine in children, there are no RCTs on their pediatric use while RCTs investigating new biologic agents have been performed. What is New: • In this manuscript, an Italian multidisciplinary team of experts focused on treatment recommendations for severe forms of psoriasis in children based on an up-to-date review of the literature and experts' opinions.
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Affiliation(s)
- Anna Belloni Fortina
- Pediatric Dermatology Unit, Department of Medicine, University of Padua, Via Gallucci, 4, 35128, Padova, Italy.
| | - Federico Bardazzi
- Dermatology Unit, Department of Specialistic, Diagnostic and Experimental Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Samantha Berti
- Dermatology Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Claudia Carnevale
- Dermatology Unit, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
| | - Vito Di Lernia
- Dermatology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy
| | - Maya El Hachem
- Dermatology Unit, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
| | - Iria Neri
- Dermatology Unit, Department of Specialistic, Diagnostic and Experimental Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Carlo Mario Gelmetti
- Pediatric Dermatology Unit, Fondazione IRCCS Ca' Granda "Ospedale Maggiore Policlinico", Milan Department of Pathophysiology and Transplantation, University of Milan, Milano, Italy
| | - Viviana Lora
- Center for the Study and Treatment of Psoriasis, San Gallicano Dermatologic Institute, IRCCS, Rome, Italy
| | - Carlo Mazzatenta
- Dermatology Unit, "Campo di Marte" Hospital, Azienda USL 2, Lucca, Italy
| | - Mirella Milioto
- Dermatology Unit, Ospedale Civico di Cristina Benfratelli, Palermo, Italy
| | - Gaia Moretta
- Department of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Annalisa Patrizi
- Dermatology Unit, Department of Specialistic, Diagnostic and Experimental Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Ketty Peris
- Department of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Alberto Villani
- General Pediatrics and Infectious Disease, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
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