Review of treatments for generalized pustular psoriasis

Kearns, Donovan G; Chat, Vipawee S; Zang, Peter; Han, George; Wu, Jashin J.

doi:10.1080/09546634.2019.1682502

Cited by 25 publications

(37 citation statements)

References 27 publications

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“…Existing treatments to manage signs and symptoms of GPP include topical and systemic therapy, and phototherapy 1,10,11 . Although, there are currently no approved treatments for GPP in the United States (US), patients are treated similarly to plaque psoriasis patients and may receive cyclosporine or a biologic such as infliximab to stabilize their condition 10,11 . Other therapies include adalimumab, etanercept, and combination of a systemic agent such as acitretin, cyclosporine, methotrexate, or apremilast and a biologic [10][11][12] .…”

Section: Introductionmentioning

confidence: 99%

Characteristics of hospitalizations and emergency department visits due to generalized pustular psoriasis in the United States

Hanna

Singer

Bender

et al. 2021

Current Medical Research and Opinion

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Objectives: Generalized pustular psoriasis (GPP) is a rare and severe, inflammatory skin disease. GPP is characterized by recurrent flares that consist of disseminated erythematous skin rash with sterile neutrophil-filled pustules that can result in an emergency department (ED) visit or hospital stay due to systemic complications. This study characterizes hospitalizations, ED visits, and inpatient treatment due to GPP in the United States (US). Methods: A descriptive, retrospective cross-sectional analysis was conducted in Cerner Health Facts, a US electronic medical record database. Hospitalizations and ED visits were identified between 1 October 2015 and 1 July 2017. Visits were included in the study if they were GPP-related, defined as a GPP diagnosis (ICD-10-CM code: L40.1) in the first or second position at admission or discharge, and if the discharge date was within the study period. Hospitalizations and ED visits were the units of analysis. Demographics, comorbidities, medication use, and outcomes were characterized with descriptive statistics. Outcomes included length of stay, intensive care unit (ICU) admission, and death. Results: A total of 71 GPP-related hospitalizations and 64 GPP-related ED visits were included in the study. Other specified inflammatory skin conditions (OSICS)/skin and subcutaneous tissue infections (54%/34%), fluid and electrolyte disorders (46%), hypertension (30%), septicemia (24%), and acute renal failure (18%) were the most frequently coded conditions accompanying a GPP-related hospitalization. OSICS/skin and subcutaneous tissue infections (47%/42%) were the most commonly coded conditions accompanying a GPP-related ED visit. Medication use during GPP-related hospitalizations included topicals (triamcinolone (42%); clobetasol (17%)), systemic corticosteroids (prednisone (20%); methylprednisolone (11%)), and non-biologic and biologic immunosuppressants (cyclosporine (6%); methotrexate (4%); etanercept (1%)). Analgesics (acetaminophen 67%; morphine 24%), and antibiotics (vancomycin 21%) were also common. The median length of stay for hospitalizations was 5 days. Three hospitalizations included an ICU admission and two hospitalizations resulted in death. Conclusions: The presence of concurrent immune-mediated conditions, and frequent prescribing of analgesics, including opioids, illustrate the burden of GPP in patients requiring acute and inpatient care.

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Section: Introductionmentioning

confidence: 99%

Characteristics of hospitalizations and emergency department visits due to generalized pustular psoriasis in the United States

Hanna

Singer

Bender

et al. 2021

Current Medical Research and Opinion

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“…There is also evidence supporting the use of methotrexate, adalimumab, ixekizumab, secukinumab, brodalumab and guselkumab to treat GPP patients and, based on our collective experience, we advise their use in these patients 70–74 . There is less robust evidence based on limited case series and case reports supporting the use of infliximab, etanercept, ustekinumab, risankizumab, tildrakizumab, apremilast and cyclosporine in GPP patients 75,76 . We do not recommend the use of fumarates in the systemic treatment of GPP patients, due their slow mode of action and potential hypersensitivity reactions worsening the disease.…”

Section: Resultsmentioning

confidence: 95%

“…[70][71][72][73][74] There is less robust evidence based on limited case series and case reports supporting the use of infliximab, etanercept, ustekinumab, risankizumab, tildrakizumab, apremilast and cyclosporine in GPP patients. 75,76 We do not recommend the use of fumarates in the systemic treatment of GPP patients, due their slow mode of action and potential hypersensitivity reactions worsening the disease.…”

Section: Clinical Recommendationsmentioning

confidence: 99%

Practical recommendations for systemic treatment in psoriasis according to age, pregnancy, metabolic syndrome, mental health, psoriasis subtype and treatment history (BETA‐PSO: Belgian Evidence‐based Treatment Advice in Psoriasis; part 1)

Lambert

Segaert²,

Ghislain

et al. 2020

Acad Dermatol Venereol

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Background Impressive progress in new therapeutic options has been made for psoriasis. Treatments include topical steroids, phototherapy, conventional, synthetic disease-modifying drugs and an expanding list of biologics. Objective The primary objective of this work was to collect evidence for the creation of practice guidelines for systemic treatment of psoriasis (BETA-PSO: Belgian Evidence-based Treatment Advice in Psoriasis). Methods Evidence-based recommendations were formulated using a quasi-Delphi methodology after a systematic search of the literature and a consensus procedure involving 8 psoriasis experts. Results In this part, the use of systemic treatment in different age groups, during pregnancy, in metabolic syndrome, in patients with mental health problems, in different psoriasis subtypes and in previously systemically treated patients treatment is discussed. Conclusion Guidance on therapeutic choice in specific clinical situations in psoriasis is provided in order to facilitate the decision-making in clinical practice.

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“…Generalized pustular psoriasis of von Zumbusch (GPP‐VZ) is a rare variant of psoriasis which develops rapidly and can be life‐threatening 1 . Unfortunately, the choice of treatment for GPP‐VZ is often limited by the complications of patients 2 . Lymphoplasma exchange (LPE) is a safe and effective treatment to alleviate the immuno‐inflammation of disease quickly 3 .…”

Section: Figurementioning

confidence: 99%

“…the complications of patients. 2 Lymphoplasma exchange (LPE) is a safe and effective treatment to alleviate the immuno-inflammation of disease quickly. 3 This is the first reported case of a patient with GPP-VZ who was successfully treated with LPE.…”

mentioning

confidence: 99%

Successful use of lymphoplasma exchange in a patient with acute generalized pustular psoriasis of von Zumbusch

Zhang

Zhu

et al. 2020

Dermatologic Therapy

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Review of treatments for generalized pustular psoriasis

Cited by 25 publications

References 27 publications

Characteristics of hospitalizations and emergency department visits due to generalized pustular psoriasis in the United States

Characteristics of hospitalizations and emergency department visits due to generalized pustular psoriasis in the United States

Practical recommendations for systemic treatment in psoriasis according to age, pregnancy, metabolic syndrome, mental health, psoriasis subtype and treatment history (BETA‐PSO: Belgian Evidence‐based Treatment Advice in Psoriasis; part 1)

Successful use of lymphoplasma exchange in a patient with acute generalized pustular psoriasis of von Zumbusch

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