Treatment of pustular psoriasis: From the Medical Board of the National Psoriasis Foundation

Robinson, Amanda; Voorhees, Abby S. Van; Hsu, Sylvia; Korman, Neil J.; Lebwohl, Mark; Bebo, Bruce F.; Kalb, Robert E.

doi:10.1016/j.jaad.2011.01.032

Cited by 213 publications

(321 citation statements)

References 70 publications

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“…Do tej pory znanych było niewiele doniesień na temat zastosowania leczenia biologicznego u pacjentów z łuszczycą krostkową, jednak pojawia się coraz więcej prac dotyczących jego skuteczności. Uważa się, że lekami pierwszego rzutu w terapii łuszczycy krostkowej są acytretyna, cyklosporyna, metotreksat oraz infliksymab, a w drugim rzucie należy rozważyć adalimumab, etanercept lub fotochemioterapię (PUVA) [5].…”

Section: Wprowadzenieunclassified

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Challenges of biological therapy in patients with pustular psoriasis coexisting with psoriatic arthritis

Trelińska¹,

Woźniacka²,

Olejniczak-Staruch³

et al. 2017

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Section: Wprowadzenieunclassified

“…First-line drugs in the treatment of pustular psoriasis include acitretin, cyclosporine, methotrexate and infliximab. Second-line therapeutic options comprise adalimumab, etanercept or photochemotherapy (PUVA) [5].…”

Section: Introductionmentioning

confidence: 99%

Challenges of biological therapy in patients with pustular psoriasis coexisting with psoriatic arthritis

Trelińska¹,

Woźniacka²,

Olejniczak-Staruch³

et al. 2017

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“…3 Terdapat beberapa pilihan terapi sistemik untuk PPG, yaitu siklosporin, metotreksat (MTX), asitretin, dan juga fumaric acid ester. 2,4 Pada kasus yang berat dan tidak memperlihatkan perbaikan sesudah dilakukan terapi tunggal, dapat dipertimbangkan pemberian terapi kombinasi. 5 Terapi kombinasi mampu meningkatkan efektivitas dan mengurangi efek samping obat.…”

Section: Pendahuluanunclassified

“…16 Menurut penelitian yang dilakukan Robinson. 4 MTX dapat diberikan pada PPG dengan dosis berkisar 5-15 mg per minggu bergantung keparahan penyakit pasien dan dapat ditingkatan 2,5 mg setiap minggu hingga didapatkan respons yang diharapkan tanpa melebihi dosis maksimal 25 mg per minggu.…”

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“…17 Dosis siklosporin adalah 2,5-5 mg/kgbb/hari, dapat ditingkatkan 0,5-1 mg/kgbb/hari setiap 2 sampai 4 minggu. 4,17 Siklosporin mempunyai efek terhadap tekanan darah dan nefrotoksis, sehingga perlu dilakukan penapisan awal berupa pemeriksaan tekanan darah dan kreatinin serum. Apabila terdapat peningkatan kreatinin serum lebih dari atau sama dengan 30% dari nilai baseline saat pasien mengonsumsi siklosporin maka dosis harus diturunkan.…”

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Keberhasilan Terapi Kombinasi Menggunakan Metotreksat Injeksi dan Siklosporin pada Psoriasis Pustulosa Generalisata

Suwarsa¹,

Nursjamsi²,

Pangastuti³

et al. 2017

mkb

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AbstrakPsoriasis pustulosa generalisata (PPG) adalah bentuk khusus dari psoriasis yang bersifat akut dan berat. Etiologi yang belum diketahui secara pasti menyebabkan pengobatan PPG masih menjadi suatu tantangan. Terapi kombinasi dapat diberikan pada PPG yang berat maupun yang tidak memberikan respons terhadap terapi sistemik tunggal, selain itu terapi kombinasi juga dapat meningkatkan efektivitas dari obat tunggal. Dilaporkan satu kasus PPG pada seorang wanita yang diterapi dengan menggunakan kombinasi metotreksat (MTX) injeksi dan siklosporin. Dari anamnesis dan pemeriksaan fisis didapatkan pustula berkelompok pada dasar makula eritem yang bergabung membentuk lake of pus, disertai gejala sistemik demam dan leukositosis. Keluhan tersebut sudah berulang sejak 13 tahun yang lalu. Pasien diberikan terapi kombinasi injeksi MTX dan siklosporin. Pustula pada pasien menghilang setelah tujuh hari pemberian obat. Succesful Treatment of Generalized Pustular Psoriasis with a Combination of Methotrexate Injection and Cyclosporine AbstractGeneralized pustular psoriasis (GPP) is a special form of acute and severe psoriasis. The definite etiology of GPP remains a challenge. Combination therapy may be given to severe GPP or GPP that does not respond to a single systemic therapy sincecombination therapy may also improve the effectiveness of a monotherapy drug. A GPP case was reported in a woman treated with a combination of methotrexate (MTX) and cyclosporine. From anamnesis and physical examination it was revealed that there were clustered pustules on the base of erythematous macules that form a lake of pus accompanied by systemic symptoms of fever and leukocytosis. This was a recurrent complaint since 13 years ago. Patients were given combination therapy of MTX injection and cyclosporine. Pustules disappeared after seven days of drug administration. This case was the first combination therapy with MTX injection and cyclosporine used during the period of 19 May to 26 May 2017 at the Department of Dermatology and Venereology Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital Bandung, resulting in good results. [MKB. 2017;49(3):208-12]

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Fever and a Pustular Rash

Yek

Gupta

Mauskar

2017

JAMA

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A previously healthy man in his 40s presented with 4 days of fever and a rash. He noticed multiple acneiform papules and pustules around the neckline that progressed to involve the face, torso, and limbs. He took no prescribed medications but had taken an ibuprofen pill a week prior for a mild headache; his symptoms started 3 days after that. He had no sick contacts or recent travel and reported no use of alcohol or tobacco.On examination, he was febrile (38.9°C) and tachycardic but normotensive. Clusters of pustules, approximately 1 mm in diameter, were present over an erythematous base overlying the face, neck, chest, back, and arms (Figure). Laboratory analysis revealed values within normal ranges for hemoglobin (13.1 g/dL) and platelet count (186 ×10 9 /L); an elevated white blood cell count (22.3 x10 9 /L; 82% neutrophils, 9% lymphocytes, 5% eosinophils, 4% monocytes); erythrocyte sedimentation rate of 58 mm/h (reference range, 0-20); C-reactive protein level of 232 mg/L (2210 nmol/L) (reference, <5 mg/dL [48 nmol/L]); and normal renal and hepatic function. Gram stain of the pustule fluid revealed no organisms, and cultures of the blood and pustule fluid were without growth. A punch biopsy of the skin lesions showed subcorneal pustules containing neutrophils and eosinophils, with epidermal spongiosis. Figure. Face, neck, and chest of the patient. WHAT WOULD YOU DO NEXT? A. Avoid further ibuprofen use and prescribe a topical steroid B. Initiate infliximab therapy C. Initiate oral cephalexin therapy D. Obtain a human immunodeficiency virus immunoassay Clinical Review & Education JAMA Clinical Challenge

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Treatment of pustular psoriasis: From the Medical Board of the National Psoriasis Foundation

Cited by 213 publications

References 70 publications

Challenges of biological therapy in patients with pustular psoriasis coexisting with psoriatic arthritis

Challenges of biological therapy in patients with pustular psoriasis coexisting with psoriatic arthritis

Keberhasilan Terapi Kombinasi Menggunakan Metotreksat Injeksi dan Siklosporin pada Psoriasis Pustulosa Generalisata

Fever and a Pustular Rash

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