Rapid response to infliximab in severe pustular psoriasis, von Zumbusch type

Abstract

Tumor necrosis factor-alpha (TNF-alpha) is a chemokine secreted by T cells which is thought to play a critical role in the pathophysiology of psoriasis. The monoclonal antibody, infliximab, complexes with TNF-alpha, rendering it inactive. A recent clinical trial has reported the clinical benefit and safety of infliximab in moderate to severe plaque psoriasis. We report a case of rapid response and clinical benefit using infliximab in severe pustular psoriasis of von Zumbusch.

Long-Term Control with Etanercept (Enbrel®) of a Severe Acrodermatitis Continua of Hallopeau Refractory to Infliximab (Remicade®)

“…The pathogenesis of this adverse event is not yet understood but may be a gap in our understanding of how these molecules work and of the exact aetiology of psoriasis. This rarely observed side effect contrasts with the reported effectiveness of this therapeutic class for the treatment of pustular psoriasis [8,9,10,11,12,13]. The case of our patient is peculiar because despite the therapeutic resistance to the first TNF-α antagonist, infliximab (Remicade), whose effectiveness for this indication has already been documented as well [14], the treatment with a molecule of the same therapeutic class has been effective.…”

Successful Treatment of Recalcitrant Palmoplantar Pustular Psoriasis with Sequential Use of Infliximab and Adalimumab

“…Based on the pivotal pathophysiological role of TNF-␣ in psoriasis and the successful treatment of chronic plaque psoriasis with TNF antagonists, clinicians have begun using these agents in the treatment of other inflammatory skin diseases including distinct phenotypes of psoriasis. Some previous case reports have shown that anti-TNF treatment may be effective in localized and generalized forms of pustular psoriasis [4][5][6][7][8][9][10] . Similarly, our case demonstrates that induction therapy with infliximab can lead to a rapid resolution of severe recalcitrant PPP.…”

“…The disease causes considerable physical disability, and treatment regimes often remain unsatisfactory [3] . Previous case reports indicate that tumor necrosis factor (TNF) inhibitors may be helpful in the treatment of pustular psoriasis [4][5][6][7][8][9][10] . However, some reports have also described paradoxical induction of pustular psoriasis by TNF inhibitors and have cautioned the use of these agents in PPP [11][12][13] .…”

Anti-TNF-α Therapy in Childhood Pustular Psoriasis

“…The initial option for infliximab was based on the publication of several isolated cases reporting its beneficial use in adults with severe forms of pustular psoriasis [3][4][5] . Some cases of severe forms of plaque psoriasis in adults [6] and children [7] have also been reported where the use of infliximab yielded considerable improvement in the lesions from the 2nd week of treatment, as happened with our patient.…”