Successful use of acitretin in conjunction with narrowband ultraviolet B phototherapy in a child with severe pustular psoriasis, von Zumbusch type

Abstract

Severe pustular psoriasis von Zumbusch type is a therapeutic challenge not only in adults, but even more in children. We report a 3(1/2)-year-old boy who developed a generalized flare of diffusely scattered pustules on erythematous skin which rapidly progressed to large exuding areas. The clinical presentation and investigations including histopathological examination of a biopsy and negative bacterial cultures were consistent with the diagnosis of pustular psoriasis von Zumbusch type. Upon initial treatment with methylprednisolone, acitretin and antibiotics the extent of the disease declined. However, several attempts to reduce the dose of the oral corticosteroid were followed by immediate severe flares. Additional treatment with narrowband ultraviolet B (NB-UVB, 311-313 nm UVB) resulted in a rapid arrest of disease activity and allowed the corticosteroid to be tapered off. After 10 irradiations the patient was both off steroid and disease free. NB-UVB therapy was subsequently reduced to twice-weekly exposures and acitretin gradually diminished to a maintenance dose of 0.3 mg kg(-1) daily. We conclude that NB-UVB in conjunction with acitretin is a potent therapeutic regimen for the treatment of severe pustular psoriasis von Zumbusch type in childhood.

Generalized pustular psoriasis of pregnancy treated with narrowband UVB and topical steroids

“…8,9 A recent case report of generalized pustular psoriasis in a child was managed successfully with acitretin and narrowband UVB. 10 Narrowband UVB, being safe in pregnancy and having a better long-term side-effect profile compared with psoralen plus ultraviolet A therapy, would be a useful treatment option for this pregnancy-related dermatosis. We feel that our patient has achieved satisfactory control with the combination treatment of topical steroids and narrowband UVB.…”

Systemic Retinoid Treatment in Childhood Psoriasis: Experience of 19 Mayıs University

“…‹kinci generasyon bir aromatik retinoid olan asitretin, generalize püstüler psoriasis, eritrodermik ve fliddetli plak tip psoriasisde etkili bir tedavi seçene¤idir 3,4 . "FDA" (Food and Drug Administration) taraf›ndan eriflkin psoriasis tedavisinde onaylanan etretinat ve asitretin, çocuklarda da baflar›yla ve güvenle kullan›lmakla birlikte hala bu konudaki çal›flma-lar yetersizdir.…”

“…‹lginç olarak son y›llarda literatürde birçok yazar, bu olgu bildirimlerinin tersine kronik retinoid kullanan hastalar›nda herhangi bir kemik toksisitesi veya büyüme gerili¤i saptamad›klar›n› bildirmifllerdir. Keratinizasyon defekti nedeniyle 5 y›ldan uzun süreyle retinoid kullan›m› sonras›nda epifizlerin erken kapanmas›na rastlanm›flsa da psoriatik hastalar›n hiç-birinde bugüne kadar böyle bir yan etki bildirilmemifltir 3,11 . Bu yay›nlarda iktiyoz nedeniyle 5 y›la kadar uzun süre retinoid kullan›m›nda bile güvenli oldu¤u düflüncesinde olan yazarlar da vard›r 13,14 .…”

Effect of the Active Fraction of Flos Daturae on IFN-γ Induced Apoptosis in Immortalized Human Epidermal Keratinocyte Cells (HaCAT)

“…Since 1980, calcitriol [9], calcipotriol [10], cyclosporin [11], tretinoin [12], and antibacterials have been used in the treatment of psoriasis, with a variety of major or minor adverse effects. Therefore, over the past few years, research has focused on efforts to find more effective and safe substances to treat psoriasis [13,14].…”