Clinical and Laboratory Features in Acute Generalized Pustular Psoriasis

Borges‐Costa, João; Silva, Raquel; Gonçalves, Luzia; Filipe, Paulo; Soares‐de‐Almeida, Luís; Gomes, Marcio M.

doi:10.2165/11586900-000000000-00000

Cited by 86 publications

(118 citation statements)

References 21 publications

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“…Generalized pustular psoriasis (GPP) of von Zumbusch is characterized by a sudden eruption of generalized painful pustules on an erythematous base which coalesce into lakes of pus, with high-grade fever, leukocytosis and elevated serum C-reactive protein [1]. It is potentially life-threatening and generally requires early administration of systemic anti-inflammatory agents such as oral retinoids, cyclosporine or methotrexate.…”

Section: Introductionmentioning

confidence: 99%

Rapid Downregulation of Innate Immune Cells, Interleukin-12 and Interleukin-23 in Generalized Pustular Psoriasis with Infliximab in Combination with Acitretin

Tang¹,

Spanou²,

Tang³

et al. 2012

Dermatology

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Background: Generalized pustular psoriasis (GPP) is a severe inflammatory disease characterized by recurrent eruptions of sterile pustules on erythematous skin. Although tumor necrosis factor (TNF) antagonists may lead to a rapid resolution of GPP, the mechanism of action of these agents remains to be investigated. Here, we sought to evaluate markers of immune response in the skin of a patient who experienced a rapid amelioration of GPP after treatment with infliximab and acitretin. Methods: A skin biopsy was obtained before and 72 h after initiation of treatment. Immunohistochemical stainings were performed to characterize alterations of the infiltrates, the apoptosis marker caspase 3 and key cytokines like TNFα, interleukin (IL)-12, IL-23 and the chemokine CXCL8/IL-8. Results: Parallel with clinical improvement, a striking decline of neutrophils, myeloid and plasmacytoid dendritic cells, M1 macrophages and partly of CD4+ T cells was observed. There was no evidence of increased apoptosis mediated through the caspase-3 pathway. A marked reduction particularly of IL-12 and IL-23 and, to a lesser degree, of TNFα and CXCL8/IL-8 was observed. Conclusion: A swift clinical improvement of GPP by infliximab and acitretin is associated with a marked reduction particularly of innate and partially of the acquired immune cells as well as IL-12 and IL-23.

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Section: Introductionmentioning

confidence: 99%

Rapid Downregulation of Innate Immune Cells, Interleukin-12 and Interleukin-23 in Generalized Pustular Psoriasis with Infliximab in Combination with Acitretin

Tang¹,

Spanou²,

Tang³

et al. 2012

Dermatology

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“…The presence of varying degrees of liver cell damage with elevations in the liver function tests in patients with psoriasis was reported and psoriasis itself may cause damage to the liver, which is relatively less than the damage caused by HCV. [9] There is an association between higher titers of ALT and AST and the severity of psoriasis. The presence of abnormal biological liver parameters in 47% of patients with generalized pustular psoriasis, which is not attributed to methotrexate treatment indicates the effect of psoriasis on liver condition.…”

Section: Discussionmentioning

confidence: 99%

“…The presence of abnormal biological liver parameters in 47% of patients with generalized pustular psoriasis, which is not attributed to methotrexate treatment indicates the effect of psoriasis on liver condition. [9] The prevalence of HCV infection in psoriasis patients may add to liver dysfunction.…”

Section: Discussionmentioning

confidence: 99%

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Apoptosis and clinical severity in patients with psoriasis and HCV infection

Gabr

Berika²,

Alghadir

2014

Indian J Dermatol

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Background:It has been proposed that hepatitis C virus (HCV) antigens are involved in the pathogenesis of psoriasis and may contribute to severity of the disease. Increased expression of the apoptosis-regulating proteins p53 and tTG and decreased levels of bcl-2 in the keratinocytes of the skin of psoriatic patients have been reported.Aim:This study aims to identify the serum levels of apoptosis-regulating proteins in patients with psoriasis and without HCV infection and to study the relation between clinical severity of psoriasis and the presence of HCV infection.Materials and Methods:Disease severity was assessed by psoriasis area severity index score (PASI) of 90 patients with psoriasis grouped as mild (n = 30), moderate (n = 30) and severe (n = 30); 20 healthy individuals were used as controls. All groups were subjected for complete history taking, clinical examination, and tests for liver function and HCV infection. The serum levels of apoptosis related proteins: p53, tTG and bcl-2 were estimated by enzyme linked immune sorbent assay (ELISA).Results:There was a statistically significant (P < 0.001) correlation between clinical severity of psoriasis and presence of HCV antibodies and HCV-mRNA. In addition, significantly (P < 0.001) raised serum p53 and tTG, and reduced bcl-2 were observed among HCV-positive patients as compared to HCV-negative patients and control patients.Conclusion:These results conclude that clinical severity of psoriasis is affected by the presence of HCV antibodies and overexpression of apoptotic related proteins. In addition, altered serum levels of apoptosis-regulating proteins could be useful prognostic markers and therapeutic targets of psoriatic disease.

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“…Factors such as infections, pregnancy, drugs [3,4] and their sudden withdrawal [5,6] are considered as possible triggers of skin lesions. The flares of pustules are accompanied by fever, leucocytosis and liver abnormalities [7,8].…”

mentioning

confidence: 99%

Diagnostic difficulties in a patient with generalized pustular psoriasis

Juczyńska¹

2014

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Introduction.Generalized pustular psoriasis is an uncommon, severe form of psoriasis. It may have a chronic, recurrent clinical course after rapid onset. Objective. To present diagnostic problems in a patient with a medical history of rheumatoid arthritis and sudden onset of generalized pustular eruption. Case report. A 66-year-old patient with rheumatoid arthritis, treated with immunosuppressants, was admitted to our department with acute, generalized pustular eruption. Histopathological findings in skin biopsy were equivocal; however, clinical diagnosis of pustular psoriasis was established. The diagnosis was sustained in longer perspective as slow regression of pustular eruptions and chronic, recurrent nature of skin lesions were observed. Conclusions. The presented case report along with data from the literature indicate that clinical and histopathological diagnosis of pustular psoriasis can be difficult. It is suggested that immunosuppressive therapy can affect both histopathological findings and therapy outcome. streszczenie Wprowadzenie. Uogólniona łuszczyca krostkowa jest rzadką, ciężką postacią łuszczycy. Po nagłym początku może mieć przewlekły, nawrotowy przebieg. Cel pracy. Przedstawienie problemów diagnostycznych u pacjenta z reumatoidalnym zapaleniem stawów i nagłym wysiewem uogólnionych zmian krostkowych. Opis przypadku. Pacjent 66-letni z reumatoidalnym zapaleniem stawów, leczony lekami immunosupresyjnymi, został przyjęty do Kliniki z nagłym uogólnionym wysiewem zmian krostkowych. Choć wynik badania histopatologicznego był niejednoznaczny, ustalono rozpoznanie łuszczycy krostkowej. Powolne ustępowanie zmian skórnych i ich przewlekły, nawracający charakter podtrzymały postawioną diagnozę. Wnioski. Przedstawiony przypadek oraz dane z piśmiennictwa wskazują, że kliniczna i histopatologiczna diagnoza łuszczycy krostkowej może nastręczać trudności. Sugeruje się, że leczenie immunosupresyjne może wpływać zarówno na wynik badania histopatologicznego, jak i efekty leczenia.

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Clinical and Laboratory Features in Acute Generalized Pustular Psoriasis

Cited by 86 publications

References 21 publications

Rapid Downregulation of Innate Immune Cells, Interleukin-12 and Interleukin-23 in Generalized Pustular Psoriasis with Infliximab in Combination with Acitretin

Rapid Downregulation of Innate Immune Cells, Interleukin-12 and Interleukin-23 in Generalized Pustular Psoriasis with Infliximab in Combination with Acitretin

Apoptosis and clinical severity in patients with psoriasis and HCV infection

Diagnostic difficulties in a patient with generalized pustular psoriasis

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