Juvenile generalized pustular psoriasis treated with etanercept

Abstract

An 8-year-old boy with general pustular psoriasis (GPP) and iatrogenic secondary Cushing syndrome was treated successfully with etanercept after he had failed on acitretin, methotrexate, and methylprednisolone therapy. GPP is a severe and very rare variant of psoriasis in children often accompanied by life-threatening complications. Retinoids, cyclosporine, methotrexate, or dapsone used in a small number of case series and case reports were effective. Etanercept is a recombinant human tumor necrosis factor-alpha (TNF-alpha) receptor protein fused with Fc portion of IgG1 that binds to TNF-alpha, approved by Food and Drug Administration for the treatment of moderate-to-severe plaque psoriasis in children and teens who have not responded to other psoriasis treatments. In our patient, etanercept demonstrated significant clinical response associated with long-term efficacy without acute exacerbation, excellent tolerability, and good safety profile.

Juvenile generalized pustular psoriasis is a chronic recalcitrant disease: an analysis of 27 patients seen in a tertiary hospital in Johor, Malaysia

“…Prednisolone was used for pregnancy‐induced GPP in Patient 14 before cyclosporine was available, but response was inadequate. Although biologics were reported to be useful in juvenile GPP, we have no experience in using them because biologics are not registered for the treatment of pediatric psoriasis in Malaysia. Recently, we successfully induced remission of a severe protracted flare in Patient 20 with a single dose of infliximab 5 mg/kg b.w.…”

Generalized pustular psoriasis: a review and update on treatment

“…80 Second-line therapy includes adalimumab, infliximab and UVB phototherapy in combination with a systemic therapy. 81,82 Corticosteroids should be utilized with caution, especially in patients with concomitant psoriasis vulgaris because of the potential to initiate flares. PUVA should not be used in children under age of 12 years.…”

A case of refractory chronic neutrophilic pustular folliculitis treated with adalimumab

“…However, patients with Sweet's syndrome and subcorneal pustulosis have elevated levels of TNF‐alpha in skin lesions suggesting a significant role of this proinflammatory cytokine in neutrophilic dermatoses . Also, it is possible that the immunological response in patients with pustular neutrophilic folliculitis shares similarities with other noninfectious inflammatory pustular skin diseases such as pustular psoriasis and acrodermatitis continua of Hallopeau, which in some cases have been shown to respond to TNF‐alpha inhibitors . Furthermore, the inflammatory response in pustular neutrophilic folliculitis could possibly also resemble that of perifolliculitis capitis, acne, and hidradenitis suppurativa, which are inflammatory conditions marked by elevations in certain cytokines including TNF‐alpha and which have also been shown to respond to TNF‐alpha inhibitors .…”