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Hsu HH, Wang HJ, Sun Y, Lan CC. Remarkable response to ixekizumab in a patient with generalized pustular psoriasis: a therapeutic challenge. Ital J Dermatol Venerol 2024; 159:373-374. [PMID: 38635325 DOI: 10.23736/s2784-8671.24.07745-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Affiliation(s)
- Hsin-Hui Hsu
- Department of Dermatology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan (R.O.C.)
- College of Medicine, Department of Dermatology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan (R.O.C.)
| | - Huei-Jing Wang
- Department of Dermatology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan (R.O.C.)
- College of Medicine, Department of Dermatology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan (R.O.C.)
| | - Yng Sun
- Department of Dermatology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan (R.O.C.)
- College of Medicine, Department of Dermatology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan (R.O.C.)
| | - Cheng-Che Lan
- Department of Dermatology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan (R.O.C.) -
- College of Medicine, Department of Dermatology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan (R.O.C.)
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2
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Niedźwiedź M, Narbutt J, Siekierko A, Skibińska M, Kwiek B, Sobolewska-Sztychny D, Ciążyńska M, Poznańska-Kurowska K, Gostyński A, Lesiak A. Case report: Successful treatment with biologics in a pediatric patient with a severe inflammatory skin disease and novel CARD14 mutation. Front Med (Lausanne) 2024; 11:1360248. [PMID: 38375322 PMCID: PMC10875046 DOI: 10.3389/fmed.2024.1360248] [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: 12/22/2023] [Accepted: 01/18/2024] [Indexed: 02/21/2024] Open
Abstract
CARD14 (caspase activation and recruitment domain) mutations have been associated with psoriasis vulgaris, psoriatic arthritis, generalized and palmoplantar pustular psoriasis, pityriasis rubra pilaris, and atopic dermatitis. We present a pediatric patient with a novel CARD14: c.394A > T/- (Ile123Phe) mutation, diagnosed with CARD14-associated papulosquamous eruption (CAPE), who was successfully treated with biological treatment.
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Affiliation(s)
- Michał Niedźwiedź
- Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Lodz, Lodz, Poland
- International Doctoral School, Medical University of Lodz, Lodz, Poland
| | - Joanna Narbutt
- Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Lodz, Lodz, Poland
| | | | - Małgorzata Skibińska
- Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Lodz, Lodz, Poland
| | | | - Dorota Sobolewska-Sztychny
- Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Lodz, Lodz, Poland
- Laboratory of Autoinflammatory, Genetic and Rare Skin Disorders, Medical University of Lodz, Lodz, Poland
| | - Magdalena Ciążyńska
- Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Lodz, Lodz, Poland
| | | | - Antoni Gostyński
- Department of Dermatology, Maastricht University Medical Centre, Maastricht, Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| | - Aleksandra Lesiak
- Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Lodz, Lodz, Poland
- Laboratory of Autoinflammatory, Genetic and Rare Skin Disorders, Medical University of Lodz, Lodz, Poland
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3
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Lu J, Huang D, Yang N, Qin H, Yu Y, Zhong X, Kong L, Jiang Y, Zhou J, Shi Y. Better efficacy, lower recurrence rate and decreased CD8 +T RM with guselkumab treatment for generalized pustular psoriasis: A prospective cohort study from China. Clin Immunol 2024; 259:109899. [PMID: 38185271 DOI: 10.1016/j.clim.2024.109899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/16/2023] [Accepted: 01/03/2024] [Indexed: 01/09/2024]
Abstract
Generalized pustular psoriasis (GPP) is a severe and uncommon form of psoriasis, for which treatment options are limited. There is an urgent need to expand the treatment options for GPP. Currently, adalimumab, secukinumab, and guselkumab are considered effective for GPP, but there is a lack of prospective direct comparative studies on their efficacy for GPP. We conducted a prospective, single-center, observational study on 50 GPP patients to compare the efficacy, safety, and recurrence rates of these three biologics. Adalimumab, secukinumab, and guselkumab resulted in varying degrees of improvement in patients with GPP, but guselkumab exhibited superior efficacy and a lower recurrence rate than the other two drugs. This enhanced response may be attributed to the significant reduction in CD8+ tissue-resident memory T cells within GPP lesions caused by guselkumab.
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Affiliation(s)
- Jiajing Lu
- Department of Dermatology, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai 200443, China; Institute of Psoriasis, School of Medicine, Tongji University, Shanghai 200443, China
| | - Dawei Huang
- Department of Dermatology, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai 200443, China; Institute of Psoriasis, School of Medicine, Tongji University, Shanghai 200443, China
| | - Nan Yang
- Department of Dermatology, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai 200443, China; Institute of Psoriasis, School of Medicine, Tongji University, Shanghai 200443, China
| | - Hui Qin
- Department of Dermatology, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai 200443, China; Institute of Psoriasis, School of Medicine, Tongji University, Shanghai 200443, China
| | - Yingyuan Yu
- Department of Dermatology, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai 200443, China; Institute of Psoriasis, School of Medicine, Tongji University, Shanghai 200443, China
| | - Xiaoyuan Zhong
- Department of Dermatology, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai 200443, China; Institute of Psoriasis, School of Medicine, Tongji University, Shanghai 200443, China
| | - Luyang Kong
- Department of Dermatology, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai 200443, China; Institute of Psoriasis, School of Medicine, Tongji University, Shanghai 200443, China
| | - Yuxiong Jiang
- Department of Dermatology, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai 200443, China; Institute of Psoriasis, School of Medicine, Tongji University, Shanghai 200443, China
| | - Jing Zhou
- Department of Dermatology, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai 200443, China; Institute of Psoriasis, School of Medicine, Tongji University, Shanghai 200443, China.
| | - Yuling Shi
- Department of Dermatology, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai 200443, China; Institute of Psoriasis, School of Medicine, Tongji University, Shanghai 200443, China.
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4
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Wang X, Yan X, Zang X, Yang Q. A case of refractory generalized pustular psoriasis treated with upadacitinib. Clin Exp Dermatol 2024; 49:170-172. [PMID: 37804531 DOI: 10.1093/ced/llad341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/21/2023] [Indexed: 10/09/2023]
Abstract
Here we report a case of upadacitinib in the treatment of generalized pustular psoriasis complicated with psoriatic arthritis. We chose upadacitinib after the use of acitretin did not work well, and achieved a tremendous therapeutic effect. Upadacitinib not only relieved the joint symptoms and fever, but also played a good role in the regression of pustules. At present, there are no successful cases of Janus kinase inhibitor use in the treatment of generalized pustular psoriasis.
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Affiliation(s)
- Xuesong Wang
- Shandong Provincial Hospital for Skin Diseases, Shandong First Medical University, Jinan, Shandong, China
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Xiaoxiao Yan
- Shandong Provincial Hospital for Skin Diseases, Shandong First Medical University, Jinan, Shandong, China
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Xiao Zang
- Shandong Provincial Hospital for Skin Diseases, Shandong First Medical University, Jinan, Shandong, China
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Qing Yang
- Shandong Provincial Hospital for Skin Diseases, Shandong First Medical University, Jinan, Shandong, China
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, Shandong, China
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5
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Bernardo D, Thaçi D, Torres T. Spesolimab for the Treatment of Generalized Pustular Psoriasis. Drugs 2024; 84:45-58. [PMID: 38114719 PMCID: PMC10789831 DOI: 10.1007/s40265-023-01988-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2023] [Indexed: 12/21/2023]
Abstract
Generalized pustular psoriasis (GPP) is a rare but severe skin inflammatory disorder characterized by the eruption of widespread sterile neutrophilic pustules, often accompanied by systemic inflammation. Given its life-threatening potential, GPP requires prompt accurate diagnosis and effective treatment, but its rarity and relapsing-remitting nature pose challenges in performing large-scale randomized controlled clinical trials. Established international guidelines are currently lacking and management guidance often follows that for plaque psoriasis. However, while it can co-exist with plaque psoriasis and has traditionally been classified as a most severe form of psoriasis, GPP is now recognized as a distinct entity, with its own clinicopathological, autoinflammatory, immunologic and genetic features. Research conducted over the past decade revealed that an imbalance of interleukin (IL)-36 signaling favoring the proinflammatory activity is the central driver of the pathogenesis of GPP, thereby laying the groundwork for the development of targeted therapies for the disease. This article reviews the evidence thus far on spesolimab, a selective humanized antibody against the IL-36 receptor that was recently licensed in Europe and the United States for the treatment of GPP flares in adults. In phase II, randomized controlled clinical trials, spesolimab led to rapid and effective skin clearance in patients experiencing a GPP flare and demonstrated superiority to placebo in preventing flares for up to 48 weeks with maintenance treatment, with reassuring safety and tolerability profiles. Spesolimab is considered to be a first-in-class medication establishing itself as the standard of care for the treatment of GPP flares, thus changing the paradigm of the management of GPP to a new era of scientifically- and evidence-based targeted therapy for this distinctive disease.
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Affiliation(s)
- Diana Bernardo
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Diamant Thaçi
- Institute and Comprehensives Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - Tiago Torres
- Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal.
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Schröder JM. Discovery of natural bispecific antibodies: Is psoriasis induced by a toxigenic Corynebacterium simulans and maintained by CIDAMPs as autoantigens? Exp Dermatol 2024; 33:e15014. [PMID: 38284202 DOI: 10.1111/exd.15014] [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: 09/25/2023] [Revised: 12/21/2023] [Accepted: 12/29/2023] [Indexed: 01/30/2024]
Abstract
The high abundance of Corynebacterium simulans in psoriasis skin suggests a contribution to the psoriasis aetiology. This hypothesis was tested in an exploratory study, where western blot (WB) analyses with extracts of heat-treated C. simulans and psoriasis serum-derived IgG exhibited a single 16 kDa-WB-band. Proteomic analyses revealed ribosomal proteins as candidate C. s.-antigens. A peptidomic analysis unexpectedly showed that psoriasis serum-derived IgG already contained 31 immunopeptides of Corynebacteria ssp., suggesting the presence of natural bispecific antibodies (BsAbs). Moreover, peptidomic analyses gave 372 DECOY-peptides with similarity to virus- and phage proteins, including Corynebacterium diphtheriae phage, and similarity to diphtheria toxin. Strikingly, a peptidomic analysis for human peptides revealed 64 epitopes of major psoriasis autoantigens such as the spacer region of filaggrin, hornerin repeats and others. Most identified immunopeptides represent potential cationic intrinsically disordered antimicrobial peptides (CIDAMPs), which are generated within the epidermis. These may form complexes with bacterial disordered protein regions, representing chimeric antigens containing discontinuous epitopes. In addition, among 128 low-abundance immunopeptides, 48 are putatively psoriasis-relevant such as epitope peptides of PGE2-, vitamin D3- and IL-10-receptors. Further, 47 immunopeptides originated from tumour antigens, and the endogenous retrovirus HERV-K. I propose that persistent infection with a toxigenic C. simulans initiates psoriasis, which is exacerbated as an autoimmune disease by CIDAMPs as autoantigens. The discovery of natural BsAbs allows the identification of antigen epitopes from microbes, viruses, autoantigens and tumour-antigens, and may help to develop epitope-specific peptide-vaccines and therapeutic approaches with antigen-specific regulatory T cells to improve immune tolerance in an autoimmune disease-specific-manner.
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Affiliation(s)
- Jens-Michael Schröder
- Department of Dermatology, University-Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Fattore D, Esposito G, Carangelo L, Luciano MA, Megna M. Atezolizumab-Induced Acrodermatitis and Pustular Psoriasis in a Patient with Non-Small Cell Lung Cancer: A Rare Case Report. Case Rep Dermatol 2024; 16:42-46. [PMID: 38384677 PMCID: PMC10881193 DOI: 10.1159/000535168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 11/08/2023] [Indexed: 02/23/2024] Open
Abstract
Introduction Immune checkpoint inhibitors are new drugs approved for the treatment of many types of malignancies. Despite their wide use and unquestionable clinical benefits, these agents have also been associated with a unique spectrum of side effects known as immune-related adverse events. In this study, we report the first case of atezolizumab-induced pustular psoriasis and acrodermatitis. Case Presentation A 61-year-old woman presented to our department with erythematous-desquamative and pustular lesions involving all hands and feet fingers, inguinal region, and trunk, associated to severe psoriatic onychodystrophy. She was affected by non-small-cell lung carcinoma from 12 years, and 7 months before admission, she started a treatment with atezolizumab. Conclusion Immune checkpoint inhibitors such as atezolizumab are linked to a plethora of adverse events. Identifying and treating certain adverse skin events, particularly in cancer patients, can be a challenge, leading oncologists to discontinue immunotherapy. Our case shows how it is necessary to have a shared therapeutic algorithm in order to manage serious skin reactions in cancer patients and avoid disruption of the oncotherapy.
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Affiliation(s)
- Davide Fattore
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples “Federico II”, Naples, Italy
| | - Gianluca Esposito
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples “Federico II”, Naples, Italy
| | - Ludovica Carangelo
- Department of Neuroscience, Reproductive Sciences and Dentistry, “Federico II” University, Naples, Italy
| | - Maria Antonietta Luciano
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples “Federico II”, Naples, Italy
| | - Matteo Megna
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples “Federico II”, Naples, Italy
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Blicharz L, Czuwara J, Rudnicka L, Torrelo A. Autoinflammatory Keratinization Diseases-The Concept, Pathophysiology, and Clinical Implications. Clin Rev Allergy Immunol 2023; 65:377-402. [PMID: 38103162 PMCID: PMC10847199 DOI: 10.1007/s12016-023-08971-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2023] [Indexed: 12/17/2023]
Abstract
Recent advances in medical genetics elucidated the background of diseases characterized by superficial dermal and epidermal inflammation with resultant aberrant keratosis. This led to introducing the term autoinflammatory keratinization diseases encompassing entities in which monogenic mutations cause spontaneous activation of the innate immunity and subsequent disruption of the keratinization process. Originally, autoinflammatory keratinization diseases were attributed to pathogenic variants of CARD14 (generalized pustular psoriasis with concomitant psoriasis vulgaris, palmoplantar pustulosis, type V pityriasis rubra pilaris), IL36RN (generalized pustular psoriasis without concomitant psoriasis vulgaris, impetigo herpetiformis, acrodermatitis continua of Hallopeau), NLRP1 (familial forms of keratosis lichenoides chronica), and genes of the mevalonate pathway, i.e., MVK, PMVK, MVD, and FDPS (porokeratosis). Since then, endotypes underlying novel entities matching the concept of autoinflammatory keratinization diseases have been discovered (mutations of JAK1, POMP, and EGFR). This review describes the concept and pathophysiology of autoinflammatory keratinization diseases and outlines the characteristic clinical features of the associated entities. Furthermore, a novel term for NLRP1-associated autoinflammatory disease with epithelial dyskeratosis (NADED) describing the spectrum of autoinflammatory keratinization diseases secondary to NLRP1 mutations is proposed.
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Affiliation(s)
- Leszek Blicharz
- Department of Dermatology, Medical University of Warsaw, 02-008, Warsaw, Poland
| | - Joanna Czuwara
- Department of Dermatology, Medical University of Warsaw, 02-008, Warsaw, Poland.
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, 02-008, Warsaw, Poland
| | - Antonio Torrelo
- Department of Dermatology, University Children's Hospital Niño Jesús, 28009, Madrid, Spain.
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9
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Gaiani FM, Malagoli P, Carrera CG. Palmoplantar pustulosis successfully treated with upadacitinib: Report of three cases. Australas J Dermatol 2023; 64:568-570. [PMID: 37607109 DOI: 10.1111/ajd.14142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/18/2023] [Accepted: 08/03/2023] [Indexed: 08/24/2023]
Affiliation(s)
- Francesca Maria Gaiani
- Department of Dermatology, IRCCS Policlinico San Donato, San Donato Milanese (MI), Italy
| | - Piergiorgio Malagoli
- Department of Dermatology, IRCCS Policlinico San Donato, San Donato Milanese (MI), Italy
| | - Carlo Giovanni Carrera
- Department of Dermatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan (MI), Italy
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10
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Rivera-Diaz R, Epelde F, Heras-Hitos JA, Martínez Virto AM, Dávalos Marin AJ, Senán Sanz MR, Carrascosa JM. Generalized pustular psoriasis: practical recommendations for Spanish primary care and emergency physicians. Postgrad Med 2023; 135:766-774. [PMID: 38019177 DOI: 10.1080/00325481.2023.2285730] [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: 07/04/2023] [Accepted: 11/15/2023] [Indexed: 11/30/2023]
Abstract
Generalized pustular psoriasis (GPP) is a rare chronic inflammatory skin disease that can lead to life-threatening complications and require emergency medical treatment. Recurrent GPP flares are characterized by the sudden onset of widespread erythematous skin rash with sterile pustules, at times associated with fever, chills, general malaise, and other systemic inflammatory manifestations. Systemic complications such as cardiorespiratory failure, infections, and sepsis are potentially life-threatening and can result in an emergency department visit and/or hospitalization. Acute GPP episodes can be difficult to recognize and diagnose. The low incidence of the disease, its relapsing nature, the unpredictability of flare onset, and the lack of standardized diagnostic criteria are major obstacles to achieving rapid recognition and diagnosis in both the emergency department and the hospital setting.There is scarce evidence supporting the efficacy and safety of treatments commonly used for GPP; consequently, there is an unmet need for therapies that specifically target the condition. Our aim is to present a multidisciplinary approach to GPP to achieve a rapid diagnosis ensuring that the patient receives the most appropriate treatment for their pathology. The main recommendation for primary care and emergency physicians is to contact a dermatologist immediately for advice or to refer the patient when GPP or a flare is suspected.
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Affiliation(s)
- Raquel Rivera-Diaz
- Departamento de Dermatología Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Francisco Epelde
- Servicio de Medicina Interna, Hospital Universitari Parc Taulí. Sabadell; Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Julio Antonio Heras-Hitos
- Servicio de Medicina de Familia, C.L. Villamanrique de Tajo (EAP Villarejo de Salvanés- DASE-Madrid), Coordinador Nacional del Grupo de Trabajo de Dermatología de Semergen, Madrid, Spain
| | - Ana María Martínez Virto
- Servicio de Medicina de Urgencias, Hospital Universitario La Paz; Coordinadora grupo enfermedades raras SEMES, Madrid, Spain
| | - Airam Jenny Dávalos Marin
- Servicio de Medicina de Urgencias, Hospital General de Segovia; Grupo de dermatología SEMG, Segovia, Spain
| | - María Rosa Senán Sanz
- Servicio de Medicina de Familia, Centro de Salud El Clot (Barcelona); Miembro del grupo de trabajo de dermatología y cirugía menor SEMFyC, Barcelona, Spain
| | - José Manuel Carrascosa
- Department of Dermatologia, Hospital Universitari Germans Trias I Pujol; Universidad Autonoma de Barcelona, Barcelona, Spain
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11
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Chularojanamontri L, Rattanakorn K, Julanon N, Chuamanochan M, Griffiths CEM. Acrodermatitis continua of Hallopeau and generalised pustular psoriasis: Should they be the same or different entities? Exp Dermatol 2023; 32:1235-1245. [PMID: 37057764 DOI: 10.1111/exd.14805] [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: 11/18/2022] [Revised: 03/26/2023] [Accepted: 03/28/2023] [Indexed: 04/15/2023]
Abstract
Pustular psoriasis is characterised by eruptions of neutrophilic sterile pustules. The European Rare and Severe Psoriasis Expert Network consensus defines pustular psoriasis into three subtypes; generalised pustular psoriasis (GPP), palmoplantar pustulosis and acrodermatitis continua of Hallopeau (ACH). Mixed forms are categorised according to their predominant features. However, the Japanese Dermatological Association includes ACH under the diagnosis of GPP. This article aims to review the similarities and differences between ACH and GPP. Based on our review, interleukin (IL)-36RN mutations, the most frequent genetic findings in pustular psoriasis are found most commonly in GPP, followed by ACH. Genotypes of IL-36RN mutations among GPP patients and ACH patients are different between European and Asian ethnicities. IL-36 signalling pathway is the main mechanism. Metabolic diseases are common comorbidities and joint involvement can occur in 20.5%-36.4% of both conditions. Associated plaque psoriasis is more common in GPP than in ACH. Generally, ACH, even the generalised type, does not have systemic inflammation whereas GPP can occur with or without systemic inflammation. ACH can occur before, simultaneously, or after the development of GPP. However, response to treatment for GPP and ACH even in the same patients appear to be different. ACH seemed to be more recalcitrant to treatment than GPP but severe flare of GPP can lead to morbidity and mortality. Although GPP and ACH share genotypes and pathogenesis, we believe that ACH should be classified separately from GPP, and not under diagnosis of GPP. Future research is warranted to satisfactorily distinguish the two conditions.
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Affiliation(s)
- Leena Chularojanamontri
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Krittaya Rattanakorn
- Division of Dermatology, Department of Medicine, Chiangrai Prachanukroh Hospital, Phayao, Thailand
| | - Narachai Julanon
- Division of Dermatology, Department of Medicine, Faculty of Medicine Srinagarind Hospital Khon Kean University, Khon Kean, Thailand
| | - Mati Chuamanochan
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Christopher E M Griffiths
- Dermatology Centre, Salford Royal Hospital, University of Manchester, NIHR Manchester Biomedical Research Centre Manchester, Salford Manchester, UK
- Department of Dermatology, King's College Hospital, King's College London, London, UK
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12
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Patel HA, Revankar RR, Pedroza ST, Graham S, Feldman SR. The Genetic Susceptibility to Psoriasis and the Relationship of Linked Genes to Our Treatment Options. Int J Mol Sci 2023; 24:12310. [PMID: 37569685 PMCID: PMC10418823 DOI: 10.3390/ijms241512310] [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: 06/14/2023] [Revised: 07/12/2023] [Accepted: 07/29/2023] [Indexed: 08/13/2023] Open
Abstract
Understanding the factors creating genetic susceptibility in psoriasis may provide a basis for improving targeted treatment strategies. In this review, we discuss the genes linked to the pathogenesis of psoriasis and their relationship to the available treatment options. To identify the relevant genetic markers and treatments, we searched PubMed, Google Scholar, MEDLINE, and Web of Science with keywords, including genetic susceptibility to psoriasis, genetics and psoriasis, psoriasis treatments, and biologics treatments in psoriasis. The articles in English from database inception to 1/1/23 were included. Case reports and series were excluded. Gene variant forms commonly implicated in the pathogenesis of psoriasis include those encoding for interleukins, interferons, and other mediators involved in inflammatory pathways, such as JAK/STAT, and NF-κB. Several of the treatments for psoriasis (for example IL23 and TYK2 inhibitors) target the products of genes linked to psoriasis. Multiple genes are linked to the pathogenesis of psoriasis. This understanding may provide an avenue for the development of new psoriasis treatment strategies and for more effective, safer treatment outcomes.
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Affiliation(s)
- Heli A. Patel
- Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, NC 27104, USA
| | | | | | - Shaveonte Graham
- Wright State University Boonshoft School of Medicine, Fairborn, OH 45435, USA
| | - Steven R. Feldman
- Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, NC 27104, USA
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC 27104, USA
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13
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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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14
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Chiu HY, Lan JL, Chiu YM. Lifetime risk, life expectancy, loss-of-life expectancy, and lifetime healthcare expenditures for psoriasis in Taiwan: a nationwide cohort followed from 2000 to 2017. Ther Adv Chronic Dis 2023; 14:20406223231168488. [PMID: 37152349 PMCID: PMC10155019 DOI: 10.1177/20406223231168488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/21/2023] [Indexed: 05/09/2023] Open
Abstract
Background Patients with psoriasis have a significant disease burden throughout the life course. Nevertheless, the lifetime risk and disease burden of psoriasis across the entire lifespan is rarely quantified in an easily understandable way. Objective To estimate the cumulative incidence rate, life expectancy, loss-of-life expectancy, and lifetime healthcare expenditures for incident psoriasis. Design and methods Using real-world nationwide data from the National Health Insurance Research Database of Taiwan for 2000-2017, along with the life tables of vital statistics, we estimated cumulative incidence rate, life expectancy, loss-of-life expectancy, and lifetime healthcare expenditures for those with psoriasis using a semi-parametric survival extrapolation method. Results A total of 217,924 new psoriasis cases were identified. The lifetime risk of psoriasis in patients aged 18-80 for both sexes decreased in Taiwan with a cumulative incidence rate of 7.93% in 2000 to 3.25% in 2017. The mean (±standard error) life expectancy after diagnosis was 27.11 (± 1.15) and 27.14 (±1.17) years for patients with moderate-to-severe psoriasis and psoriatic arthritis, respectively. Patients with moderate-to-severe psoriasis and psoriatic arthritis had a mean (±standard error) loss-of-life expectancy of 6.41 (±1.16) and 6.48 (±1.17) due to psoriasis, respectively. Male patients have higher lifetime and annual lifetime healthcare expenditures than female. Mean life expectancy, loss-of-life expectancy, and lifetime cost were relatively higher for younger patients. Conclusion Among psoriatic patients, patients with moderate-to-severe psoriasis and psoriatic arthritis had substantial years of life lost, particularly for younger patients. Our results provide a reliable estimation of lifetime disease burden, and these estimates will help health authorities in cost-effectiveness assessments of public health interventions and allocation of services resources to minimize loss-of-life expectancy, and lifetime healthcare expenditures in patients with psoriasis.
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Affiliation(s)
- Hsien-Yi Chiu
- Department of Dermatology, National Taiwan
University Hsin-Chu Hospital, Hsinchu
- Department of Dermatology, National Taiwan
University Hospital Hsin-Chu Branch, Hsinchu
- Department of Dermatology, National Taiwan
University Hospital, Taipei
- Department of Dermatology, College of Medicine,
National Taiwan University, Taipei
| | - Joung-Liang Lan
- Rheumatology and Immunology Center, China
Medical University Hospital, Taichung City
- Department of Medicine, China Medical
University, Taichung City
- Hsien-Yi Chiu is also affiliated to Department
of Medical Research, National Taiwan University Hospital Hsinchu Branch,
Hsinchu, Taiwan
| | - Ying-Ming Chiu
- Department of Allergy, Immunology, and
Rheumatology, Tungs’ Taichung MetroHarbor Hospital, No. 699, Section 8,
Taiwan Boulevard, Wuqi District, Taichung City 43503
- Department of Nursing, Jen-Teh Junior College
of Medicine, Nursing and Management, Miaoli
- Department of Post-Baccalaureate Medicine,
College of Medicine, National Chung Hsing University, Taichung City
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15
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Bellinato F, Gisondi P, Marzano AV, Piaserico S, De Simone C, Damiani G, Argenziano G, Venturini M, Dapavo P, Costanzo A, Megna M, Prignano F, Burlando M, Satolli F, Carugno A, Pezzolo E, Romanelli M, Cuccia A, Girolomoni G. Characteristics of Patients Experiencing a Flare of Generalized Pustular Psoriasis: A Multicenter Observational Study. Vaccines (Basel) 2023; 11:vaccines11040740. [PMID: 37112652 PMCID: PMC10143954 DOI: 10.3390/vaccines11040740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/14/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
Background: Generalized pustular psoriasis (GPP) is a rare, severe inflammatory skin disease characterized by recurrent episodes of flares. Characteristics of patients experiencing a flare are hardly described in a real-life setting. The aim of the study is to investigate the clinical characteristics of patients experiencing a flare of GPP. Methods: Multicenter retrospective observational study on consecutive patients experiencing a flare of GPP between 2018 and 2022. Disease severity and quality of life were assessed by Generalized Pustular Psoriasis Area, Body Surface Area (BSA), and Severity Index (GPPASI), and Dermatology life quality index (DLQI) questionnaire, respectively. Visual analogue scale (VAS) of itch and pain, triggers, complications, comorbidities, pharmacological therapies, and outcome were collected. Results: A total of 66 patients, 45 (68.2%) females, mean age 58.1 ± 14.9 years, were included. The GPPASI, BSA, and DLQI were 22.9 ± 13.5 (mean ± standard deviation), 47.9 ± 29.1, and 21.0 ± 5.0, respectively. The VAS of itch and pain were 6.2 ± 3.3 and 6.2 ± 3.0, respectively. Fever (>38 °C) and leukocytosis (WBC > 12 × 109/L) were found in 26 (39.4%) and 39 (59.1%) patients, respectively. Precipitating triggers were identified in 24 (36.3%) and included infections (15.9%), drugs (10.6%), stressful life events (7.6%), and corticosteroids withdrawal (3.0%). Fourteen (21.2%) patients were hospitalized because of complications including infections in 9 (13.6%) leading to death in one case and hepatitis in 3 (4.5%). Conclusions: GPP flares can be severe and cause severe pain and itch with significant impact on the quality of life. In about one-third of patients the flare may have a persistent course and, with complications, lead to hospitalization.
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Affiliation(s)
- Francesco Bellinato
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126 Verona, Italy
- Correspondence:
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126 Verona, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20133 Milan, Italy
| | - Stefano Piaserico
- Dermatology Unit, Department of Medicine, University of Padua, 35122 Padua, Italy
| | - Clara De Simone
- Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Dermatologia, Dipartimento Universitario Di Medicina e Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, 20123 Rome, Italy
| | - Giovanni Damiani
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20126 Milan, Italy
- Unit of Dermatology and Cosmetology, IRCCS San Raffaele Hospital, 20132 Milan, Italy
| | - Giuseppe Argenziano
- Dermatology Unit, Università Degli Studi Della Campania L. Vanvitelli, 80131 Naples, Italy
| | - Marina Venturini
- Department of Dermatology, University of Brescia at ASST-Spedali Civili, 25121 Brescia, Italy
| | - Paolo Dapavo
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10124 Turin, Italy
| | - Antonio Costanzo
- Dermatology Unit, Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
- Humanitas Clinical and Research Center, Scientific Institute for Research, Hospitalization and Healthcare, 20089 Rozzano, Italy
| | - Matteo Megna
- Section of Dermatology, Department of Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Francesca Prignano
- Section of Dermatology, Department of Health Sciences, University of Florence, 50125 Florence, Italy
| | - Martina Burlando
- Department of Dermatology, Dipartimento Della Salute-DiSSal, University of Genoa, 16126 Genoa, Italy
- IRCCS, Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Francesca Satolli
- Section of Dermatology, Department of Medicine and Surgery, University of Parma, 43100 Parma, Italy
| | - Andrea Carugno
- Dermatology Unit, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
- Ph.D. Program in Molecular and Translational Medicine (DIMET), University of Milan-Bicocca, 20126 Milan, Italy
| | - Elena Pezzolo
- Dermatology Unit, San Bortolo Hospital, 36100 Vicenza, Italy
| | - Marco Romanelli
- Department of Dermatology, University of Pisa, 56124 Pisa, Italy
| | - Aldo Cuccia
- Unit of Dermatology, San Donato Hospital, 52100 Arezzo, Italy
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126 Verona, Italy
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16
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Cirone KD, Lovegrove FE. Acrodermatitis continua of Hallopeau successfully treated with
bimekizumab: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231160937. [PMID: 36968989 PMCID: PMC10034280 DOI: 10.1177/2050313x231160937] [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: 03/24/2023] Open
Abstract
Acrodermatitis continua of Hallopeau is a rare variant of localized pustular
psoriasis characterized by the recurrent eruption of sterile pustules involving
the distal portions of the fingers and toes that can lead to the destruction of
the nail apparatus. Acrodermatitis continua of Hallopeau is a chronic, relapsing
condition that is resistant to most topical and systemic psoriasis therapies,
making it notoriously difficult to manage. Interleukin-36 and interleukin-17 are
thought to play a pivotal role in the pathophysiology of pustular psoriasis, and
evidence suggests that interleukin-17 inhibition can be an effective therapy for
pustular psoriasis variants, including acrodermatitis continua of Hallopeau.
Bimekizumab, a monoclonal antibody that inhibits the interleukin-17 pathway, may
be a safe and effective treatment option for patients with acrodermatitis
continua of Hallopeau. We present the first documented case of a patient with
acrodermatitis continua of Hallopeau of the bilateral thumbnails who experienced
an excellent response to bimekizumab treatment.
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Affiliation(s)
- Katrina D Cirone
- Schulich School of Medicine &
Dentistry, Western University, London, ON, Canada
| | - Fiona E Lovegrove
- Schulich School of Medicine &
Dentistry, Western University, London, ON, Canada
- Lovegrove Dermatology, London, ON,
Canada
- Fiona E Lovegrove, Lovegrove Dermatology,
140 Oxford Street East, Suite 207, London, ON N6A 5R9, Canada.
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17
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The Intriguing Links between Psoriasis and Bullous Pemphigoid. J Clin Med 2022; 12:jcm12010328. [PMID: 36615129 PMCID: PMC9821109 DOI: 10.3390/jcm12010328] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
The coexistence of psoriasis with autoimmune bullous diseases (AIBDs), particularly bullous pemphigoid (BP), has been documented in case reports and series, as well as in epidemiological studies. The onset of psoriasis precedes that of BP in the majority of cases. Patients with concomitant BP and psoriasis are generally younger at the onset of BP and present with fewer erosions and blisters as compared with patients suffering from isolated BP. Intriguingly, it has been speculated that some BP cases with comorbid psoriasis can actually correspond to anti-laminin gamma-1 pemphigoid, a rare form that was recently recognized as a distinct entity and which can mimic BP and/or other subepidermal AIBDs. The pathomechanisms underlying the BP-psoriasis association have not yet been identified, although several hypotheses have been proposed. The most credited among such hypotheses involves the so-called "epitope spreading" phenomenon, with tissue injury secondary to a primary inflammatory process (i.e., psoriasis) leading to the exposure of sequestered antigens evoking a secondary autoimmune disease (i.e., bullous pemphigoid). This narrative review aims to give a brief overview of the association between psoriasis and BP, examining epidemiological, clinical, and immunopathological features, the pathomechanisms underlying this association, the treatments for psoriasis incriminated as potential triggers of BP, and the therapeutic management of patients with psoriasis and BP.
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18
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Rosi E, Fastame MT, Di Cesare A, Prignano F. Targeting IL-17A for the treatment of pustular psoriasis: a comprehensive review. Expert Opin Biol Ther 2022; 22:1475-1487. [PMID: 35997143 DOI: 10.1080/14712598.2022.2116978] [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: 01/25/2023]
Abstract
INTRODUCTION Pustular psoriasis (PP) is a rare subtype of psoriasis. Overall, the growing evidence - in particular for acute generalized PP (GPP) - supports that it is a separate entity with a specific pathogenetic pathway. Interleukin (IL)-17/T-helper 17 (Th17) axis involvement may play an important role in the pathophysiology of PP. Biologicals, often required to achieve clinical remission, have changed the treatment of PP. AREAS COVERED We provide the reader with an overview of all the available evidence on the use of the antibody-based therapy targeting IL-17A in patients with PP. EXPERT OPINION Although papers reported in this review do not provide definitive evidence (due to methodological limitations) to support the use of IL-17 inhibitors as potential first-line for the treatment of PP, based on our own experience and according to most of the reported literature, targeting IL-17A, may represent the best therapeutical approach in this peculiar clinical spectrum of psoriasis.
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Affiliation(s)
- Elia Rosi
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - Maria Thais Fastame
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - Antonella Di Cesare
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - Francesca Prignano
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
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19
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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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20
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Chiricozzi A, Bellinato F, Romita P, Gisondi P. Psoriasis: talking points from recent clinical trials. Expert Opin Investig Drugs 2022; 31:1265-1267. [PMID: 36526606 DOI: 10.1080/13543784.2022.2160314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Andrea Chiricozzi
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy.,Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Bellinato
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - Paolo Romita
- Department of Biomedical Science and Human Oncology, Section of Dermatology, University of Bari, Bari, Italy
| | - Paolo Gisondi
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
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21
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Gisondi P, Bellinato F, Girolomoni G. Clinical Characteristics of Patients with Pustular Psoriasis: A Single-Center Retrospective Observational Study. Vaccines (Basel) 2022; 10:vaccines10081171. [PMID: 35893820 PMCID: PMC9331546 DOI: 10.3390/vaccines10081171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/04/2022] [Accepted: 07/21/2022] [Indexed: 11/19/2022] Open
Abstract
Clinical and epidemiologic data on pustular psoriasis are scarce. To investigate the phenotypes of pustular psoriasis and the patients’ characteristics observed in a real-life retrospective observational study. The number of incident cases of pustular psoriasis registered in the period 2005–2021 was retrieved from the electronic medical records of the University Hospital of Verona. One hundred and forty cases of pustular psoriasis were collected. Ninety-one out of 140 patients (65%) were females, with a median (IQR) age of 57 (43–66) years. According to the ERASPEN classification criteria, 116 patients (83%) had palmoplantar pustulosis (PPP), 13 (9%) generalized pustular psoriasis (GPP), and 11 (8%) acrodermatitis continua of Hallopeau (ACH). Gender distribution and median age were consistent among the three groups. The prevalence of psoriatic arthritis in GPP, ACH, and PPP was 8%, 36%, and 28%, respectively. During the same period, a total of 4718 cases of plaque psoriasis were retrieved, with a 1:34 ratio of pustular over plaque psoriasis. Pustular psoriasis is much rarer than plaque psoriasis, with PPP being the more common subtype.
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22
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Iznardo H, Puig L. Beyond plaque psoriasis - pathogenesis and treatment of other psoriasis phenotypes. Curr Opin Rheumatol 2022; 34:225-234. [PMID: 35699337 DOI: 10.1097/bor.0000000000000882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Psoriasis vulgaris is the commonest presentation of psoriatic disease, but morphologic variants such as pustular psoriasis (PP) and a closely related disease, pityriasis rubra pilaris (PRP), have been known for a long time, have been associated with rheumatologic manifestations indistinguishable from psoriatic arthritis (PsA) that may go unrecognized, and often represent a therapeutic conundrum. There is recent evidence that underlying genetic and pathogenetic differences may provide the basis for newer therapeutic approaches. RECENT FINDINGS This narrative review highlights the clinical, genetic and pathogenetic characteristics of PP and PRP, their association with PsA and recent developments in their treatment, especially with biologic agents targeting IL-36 and other cytokines of pathogenic relevance. SUMMARY The clinical manifestations of PP and PRP are less well known to rheumatologists than those of psoriasis, and recent advances in our insight on their pathogenesis may eventually overcome the therapeutic difficulties faced by dermatologists and rheumatologists in the management of these diseases and their rheumatologic manifestations.
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Affiliation(s)
- Helena Iznardo
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma, Barcelona, Spain
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23
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Seishima M, Fujii K, Mizutani Y. Generalized Pustular Psoriasis in Pregnancy: Current and Future Treatments. Am J Clin Dermatol 2022; 23:661-671. [PMID: 35704168 DOI: 10.1007/s40257-022-00698-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 11/28/2022]
Abstract
Generalized pustular psoriasis (GPP) is a rare, severe neutrophilic skin disease characterized by sudden widespread eruption of sterile pustules with or without systemic symptoms. GPP may be life threatening in cases with severe complications such as cardiovascular failure, acute respiratory distress syndrome, and serious infections. Impetigo herpetiformis (IH) is a GPP that is induced and exacerbated by pregnancy and occurs most frequently during the last trimester. IH may result in poor or fatal neonatal outcomes, including placental insufficiency, fetal abnormalities, stillbirth, and early neonatal death. Most patients have prompt remission in the postpartum period; however, earlier appearance and more severe symptoms are observed during subsequent pregnancies. Appropriate treatment and close monitoring of the mother and fetus are vital for the management of patients with IH. Particular attention is required for the management of patients with IH to avoid an influence on the fetus. However, data regarding treatments for GPP in pregnant women are sparse. Over the last decade, many patients with IH have been treated with cyclosporine, corticosteroids, tumor necrosis factor-α inhibitors, interleukin (IL)-17 and IL-12/23 inhibitors, and granulocyte and monocyte adsorption apheresis (GMA). GMA may be an important option for patients with IH as it is presently one of the safest available therapeutic options, but there have been no reports to fully confirm its safety in pregnant patients with GPP. Alternatively, based on recent advances in the understanding of the role of the IL-36 axis in the pathogenesis of GPP, biologic agents that target the IL-36 pathway may demonstrate promising efficacy in IH.
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Affiliation(s)
- Mariko Seishima
- Department of Dermatology, Gifu University Graduate School of Medicine, 1-1, Yanagido, Gifu, 501-1194, Japan. .,Department of Dermatology, Asahi University Hospital, 3-23, Hashimoto-cho, Gifu, 500-8523, Japan.
| | - Kento Fujii
- Department of Dermatology, Gifu University Graduate School of Medicine, 1-1, Yanagido, Gifu, 501-1194, Japan
| | - Yoko Mizutani
- Department of Dermatology, Gifu University Graduate School of Medicine, 1-1, Yanagido, Gifu, 501-1194, Japan
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24
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The Challenge Arising from New Knowledge about Immune and Inflammatory Skin Diseases: Where We Are Today and Where We Are Going. Biomedicines 2022; 10:biomedicines10050950. [PMID: 35625686 PMCID: PMC9138773 DOI: 10.3390/biomedicines10050950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022] Open
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