Case report: Successful treatment of acute generalized pustular psoriasis of puerperium with secukinumab

Abstract

Generalized pustular psoriasis (GPP) is a rare and severe form of psoriasis presenting with erythematous, aseptic pustules. Common systemic symptoms include fever and myalgias. The presentation of GPP resembles acute generalized exanthematous pustulosis (AGEP). However, the treatment of these two pathologies differs. While AGEP is self-limiting and treated with topical corticosteroids and constrain of systemic steroids. GPP treatment avoids corticosteroid, choosing acitretin, methotrexate, and cyclosporine as first-line agents. In this case report, a 27-year-old female with a medical history of AGEP presented to the hospital with extensive erythema and pustules. Complete blood count acute phase reactant analysis revealed an elevated white blood cell count and C-reactive protein (CRP). Two histopathological examinations revealed psoriatic hyperplasia of the epidermis with keratosis, along with Kogoj and Munro micro abscesses above the spina layer. Lymphocytic and neutrophilic infiltrate was present in the superficial derma layer along with vasodilation. The patient was diagnosed with GPP according to pathological and clinical criteria. Treatment was initiated with secukinumab because of the patient’s failure to respond to systemic treatment with Acitretin, methotrexate, and cyclosporin. Following 2 weeks of therapy with 300 mg of secukinumab, the pustular lesions had resolved. This study indicates the potential efficacy of secukinumab as an effective therapy that can rapidly improve the clinical symptoms of GPP.

Successful secukinumab treatment of generalized pustular psoriasis

“…Secukinumab was first reported for use in GPP in 2016 [10]. It has been demonstrated to have a high response rate with rapid improvement in erythematous areas and pustules in adult patients with GPP and those with pustular psoriasis of pregnancy [11][12][13][14][15]. The neutrophil-keratinocyte axis in GPP as the early target of secukinumab may explain its efficacy [16].…”

Use of Biological Therapies for the Management of Pustular Psoriasis: A New Era?

“…94 Several case reports seem to confirm these results, [95][96][97][98][99][100][101][102] also during pregnancy. 103,104 Secukinumab seems to be a valuable weapon for GPP also in pediatric patients, as reported in a 48-week retrospective real-world study involving 18 pediatric patients (mean age 7.9 ± 2.3 years) receiving secukinumab 75 mg at weeks 0, 1, 2, 3, and 4 and then every 4 weeks, with the purpose of assessing the change in the Generalized Pustular Psoriasis Area and Severity Index (GPPASI) and Generalized Pustular Psoriasis Physician Global Assessment (GPPGA) scores from the baseline to weeks 2, 4, 12, 24, and 48. 105 GPPASI scored from 31.7 (baseline) to 5.1 at week 2, continuing to decrease to 1.3 (week 4), and maintaining clinical response up to week 48.…”

Case report: Successful treatment of acute generalized pustular psoriasis with multiple comorbidities with oral tacrolimus

“…Thus far, five subtypes have been described. Acute GPP is the most grievous subtype, and it is often accompanied by systemic symptoms, such as fever, general malaise, anorexia, nausea, and myalgias ( 3 ). Common treatments for this disease include methotrexate, cyclosporine, acitretin, corticosteroids, biologics, topical therapy, and phototherapy ( 4 ).…”