ReviewTreatment of pustular psoriasis: From the Medical Board of the National Psoriasis Foundation
Section snippets
Methods
This article is a review of the established and current therapies for pustular psoriasis. The MEDLINE terms used were “pustular psoriasis,” “generalized pustular psoriasis,” “impetigo herpetiformis,” “acrodermatitis continua of Hallopeau,” “palmoplantar pustular psoriasis,” “pustular psoriasis in pregnancy,” “juvenile pustular psoriasis,” “pustular psoriasis in childhood,” “pustulosis palmaris et plantaris,” and “pustular psoriasis of the nail.”
Articles were graded using levels of evidence
Evidence and discussion
The recommendations for the treatment of pustular psoriasis included in this review are primarily based on uncontrolled and open-label reports. There is a lack of evidence-based reports and randomized controlled trials to guide therapeutic recommendations. The only therapeutic guidelines for GPP in the literature, a study by Umezawa et al,4 suggests assessing disease severity using the Ohkawara classification.16 This takes into account skin symptoms, constitutional symptoms, and laboratory
References (83)
Infliximab for the treatment of severe pustular psoriasis
J Am Acad Dermatol
(2002)- et al.
Acitretin induces capillary leak syndrome in a patient with pustular psoriasis
J Am Acad Dermatol
(2007) - et al.
Methotrexate in psoriasis: consensus conference
J Am Acad Dermatol
(1998) - et al.
Methotrexate and psoriasis: National Psoriasis Foundation consensus conference
J Am Acad Dermatol
(2009) - et al.
Generalized pustular psoriasis of pregnancy treated with narrowband UVB and topical steroids
J Am Acad Dermatol
(2006) - et al.
National Transplantation Pregnancy Registry: report on outcomes of cyclosporine-treated female kidney transplant recipients with an interval from transplantation to pregnancy of greater than five years
Am J Kidney Dis
(1996) - et al.
Topical psoralen-ultraviolet A therapy for palmoplantar dermatoses: experience with 35 consecutive patients
Mayo Clin Proc
(1998) Be prepared to treat pustular psoriasis–an uncommon variant. Pustular psoriasis is a rare form of psoriasis that may require different approaches to treatment
Practical Dermatol
(2007)- et al.
Childhood psoriasis: an epidemiologic survey of 112 patients
Pediatr Dermatol
(1990) - et al.
The use of cyclosporin in a child with generalized pustular psoriasis
Br J Dermatol
(1998)
Therapeutic guidelines for the treatment of generalized pustular psoriasis (GPP) based on a proposed classification of disease severity
Arch Dermatol Res
The relationship of onset and exacerbation of pustulosis palmaris et plantaris to smoking and focal infections
J Dermatol
Psoriasis induced by tumor necrosis factor-alpha antagonist therapy: a case series
J Rheumatol
Pustular psoriasis induced by infliximab
J Drugs Dermatol
Onset of psoriasis during treatment with TNF-alpha antagonists: a report of 3 cases
Arch Dermatol
Psoriasiform drug eruptions under anti-TNF treatment of arthritis are not true psoriasis
Acta Derm Venereol
Precipitation of generalized pustular psoriasis by prednisolone
Clin Exp Dermatol
Generalized pustular psoriasis precipitated by topical calcipotriol cream
Int J Dermatol
Generalized pustular psoriasis developing during withdrawal of short-term cyclosporin therapy
Br J Dermatol
Generalized pustular psoriasis following withdrawal of oral cyclosporin treatment for palmo-plantar pustulosis
Clin Exp Dermatol
Treatments of general pustular psoriasis: a multicenter study in Japan
J Dermatol
Clinical guidelines: developing guidelines
BMJ
To propose the diagnostic criteria for severity rating of pustular psoriasis. A report of the MHW investigation and research team in specific and rarerefractory skin diseases in 1997
Pustular skin disorders: diagnosis and treatment
Am J Clin Dermatol
The efficacy of methotrexate in psoriasis–a review of 40 cases
Clin Exp Dermatol
A follow-up study in 28 patients treated with infliximab for severe recalcitrant psoriasis: evidence for efficacy and high incidence of biological autoimmunity
Br J Dermatol
Sequential use of infliximab and etanercept in generalized pustular psoriasis
Cutis
Isotretinoin vs etretinate therapy in generalized pustular and chronic psoriasis
Arch Dermatol
Adalimumab: safe and successful in severe pustular psoriasis
J Eur Acad Dermatol Venereol
Treatment of recalcitrant von Zumbusch pustular psoriasis with etanercept: P2753
J Am Acad Dermatol
Generalized pustular psoriasis induced by cyclosporin a withdrawal responding to the tumor necrosis factor alpha inhibitor etanercept
Dermatology
Etanercept at different dosages in the treatment of generalized pustular psoriasis: a case series
Dermatology
Generalized pustular psoriasis responsive to PUVA and oral cyclosporin therapy
Australas J Dermatol
The combination of oral acitretin and bath PUVA for the treatment of severe psoriasis
Br J Dermatol
Photochemotherapy for pustular psoriasis (von Zumbusch)
Br J Dermatol
A case of generalized pustular psoriasis treated with topical tacrolimus
Arch Dermatol
Generalized pustular psoriasis successfully treated with topical tacrolimus
Br J Dermatol
Treatment of recalcitrant pustular psoriasis with infliximab: effective reduction of chemokine expression
Br J Dermatol
Addition of low-dose methotrexate to infliximab in the treatment of a patient with severe, recalcitrant pustular psoriasis
Arch Dermatol
Long-term management of generalized pustular psoriasis with infliximab: case series
J Cutan Med Surg
The treatment of psoriasis with etretinate and acitretin: a follow up of actual use
Eur J Dermatol
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2024, Journal of the European Academy of Dermatology and Venereology
Funding sources: None.
Disclosure: Dr Van Voorhees has served as a consultant/speaker/advisor for Amgen, Abbott, Centocor, Genentech, Warner Chilcott, and Leo. She has been an investigator for Amgen and Genentech. She has served on a drug safety monitoring board for Synta. Dr Hsu has been a consultant for Abbott, Amgen, Biogen Idec, Centocor, and Genentech. She has been a clinical investigator for Amgen and Centocor. Dr Korman has been a consultant for Abbott, Astellas, Centocor, and Genentech; he has also been a speaker for Abbott, Amgen, Astellas, Centocor, and Genentech. Dr Lebwohl has been a consultant for Abbott, Amgen, Astellas, Centocor, Genentech, Galderma, Leo Pharma, and Novartis. Dr Bebo is employed by the National Psoriasis Foundation. The foundation receives unrestricted financial support from Abbott, Centocor, Amgen, Wyeth, Genentech, Astellas, Stiefel, Galderma, Warner Chilcott, and Photomedix. Dr Kalb has been an investigator and consultant for Abbott, Amgen, Centocor, Astellas, Warner Chilcott, and Stiefel. Dr Robinson has no conflicts of interest to declare.
Reprints not available from the authors.