Generalized pustular psoriasis. literature review and clinical experience with IL-17 inhibitor therapy
- Authors: Kokhan M.M.1, Keniksfest Y.V.1, Filimonkova N.N.1, Grishaeva E.V.1, Stukova E.I.1
-
Affiliations:
- Ural Research Institute of Dermatovenereology and Immunopathology
- Issue: Vol 32, No 5 (2025)
- Pages: 50-55
- Section: Clinical experience
- URL: https://journal-vniispk.ru/2073-4034/article/view/316491
- DOI: https://doi.org/10.18565/pharmateca.2025.5.50-55
- ID: 316491
Cite item
Abstract
The article presents current literature data on the clinical manifestations and course of generalized pustular psoriasis (GPP), which is one of the most severe forms of psoriasis. The publication briefly presents the main features of the immunopathogenesis of GPP, the role of proinflammatory interleukin IL-17 in the development of the psoriatic process, and also highlights approaches to treating the disease. Clinical cases of GPP therapy using monoclonal antibodies that inhibit proinflammatory IL-17A, which are the active ingredient of secukinumab, are presented. A pronounced clinical effect of treatment is shown. The described clinical cases indicate that the genetically engineered biological drug secukinumab can be the drug of choice in the treatment of patients with GPP when other treatment methods are ineffective, and its use is effective and safe.
Full Text
##article.viewOnOriginalSite##About the authors
Muza M. Kokhan
Ural Research Institute of Dermatovenereology and Immunopathology
Author for correspondence.
Email: mkokhan@yandex.ru
ORCID iD: 0000-0001-6353-6644
Dr. Sci. (Med.), Professor, Head of the Scientific Clinical Department of Dermatology
Russian Federation, YekaterinburgYu. V. Keniksfest
Ural Research Institute of Dermatovenereology and Immunopathology
Email: keniksfest@mail.ru
ORCID iD: 0000-0001-8431-5664
Dr. Sci. (Med.), Associate Professor, Head of the Department of Chronic Dermatoses for Adults
Russian Federation, ЕкатеринбургN. N. Filimonkova
Ural Research Institute of Dermatovenereology and Immunopathology
Email: nnfil2008@mail.ru
ORCID iD: 0000-0003-2872-3836
Dr. Sci. (Med.), Professor, Leading Researcher, Scientific Clinical Department of Dermatology
Russian Federation, YekaterinburgE. V. Grishaeva
Ural Research Institute of Dermatovenereology and Immunopathology
Email: egrishaeva@yandex.ru
ORCID iD: 0000-0001-9891-1942
Cand. Sci. (Med.), Head of Clinic
Russian Federation, YekaterinburgE. I. Stukova
Ural Research Institute of Dermatovenereology and Immunopathology
Email: evstukova@mail.ru
ORCID iD: 0000-0003-4580-7839
Cand. Sci. (Med.), Researcher, Scientific Clinical Department of Dermatology
Russian Federation, YekaterinburgReferences
- World Health Organization. Global report on Psoriasis. Geneva: World Health Organization; 2016.
- Федеральные клинические рекомендации «Псориаз». РОДВК, 2023. [Federal clinical guidelines «Psoriasis». RODVC, 2023. (In Russ.)]. URL: https://cr.minzdrav.gov.ru.
- Hoegler K.M., John A.M., Handler M.Z., et al. Generalized pustular psoriasis: a review and update on treatment. J Eur Acad Dermatol Venereol. 2018;32(10):1645–51. https://dx.doi.org/10.1111/jdv.14949
- Wang H., Jin H. Update on the etiology and mechanisms of generalized pustular psoriasis. Eur J Dermatol. 2021;31(5):602–8. https://dx.doi.org/10.1684/ejd.2021.4047
- Navarini A.A., Burden A.D., Capon F., et al. European consensus statement on phenotypes of pustular psoriasis. J Eur Acad Dermatol Venereol. 2017;31(11):1792–9. https://dx.doi.org/10.1111/jdv.14386
- Choon S.E., Navarini A.A., Pinter A. Clinical course and characteristics of generalized pustular psoriasis. Am J Clin Dermatol. 2022;23(Suppl. 1):21–9. https://dx.doi.org/10.1007/s40257-021-00654-z
- Kharawala S., Golembesky A.K., Bohn R.L., et al. The clinical, humanistic, and economic burden of generalized pustular psoriasis: a structured review. Expert Rev Clin Immunol. 2020;16:239–52. https://dx.doi.org/10.1080/1744666X.2019.1708193
- Löfvendahl S.,Norlin J.M., Schmitt-Egenolf M. Prevalence and incidence of generalized pustular psoriasis in Sweden: a population-based register study. Br J Dermatol. 2022;186(6):970–6. https://dx.doi.org/10.1111/bjd.20966
- Viguier M., Choon S.E., Griffiths C. Prevalence, comorbidities and mortality of generalized pustular psoriasis (GPP): A literature review. J Am Acad Dermatol. 2022;87(3):AB96. Doi.org/10.1016/j.jaad.2022.06.418
- Alamri A., Alqahtani R., Alshareef I., et al. Psoriasis in Saudi Population: Gender Differences in Clinical Characteristics and Quality of Life. Cureus. 2022;14(3):e22892. https://dx.doi.org/10.7759/cureus.22892
- Romiti R., Hirayama ALDS, Arnone M., et al. Generalized pustular psoriasis (von Zumbusch). An Bras Dermatol. 2022;97(1):63–74. https://dx.doi.org/10.1016/j.abd.2021.05.011
- Вachelez H., Barker J., Burden A.D., et al. Generalized pustular psoriasis is a disease distinct from psoriasis vulgaris: evidence and expert opinion. Expert Rev Clin Immunol. 2022;18(10):1033–47. https://dx.doi.org/10.1080/1744666X.2022.2116003
- Zhou J., Qing Luo Q. , Cheng Y., et al. An update on genetic basis of generalized pustular psoriasis (Review). Int J Mol Med. 2021;47(6):118. https://dx.doi.org/10.3892/ijmm.2021.4951
- Trai N.N.,Van Em D., Thi V.B., et al. Correlation of IL36RN and CARD14 mutations with clinical manifestations and laboratory findings in patients with generalised pustular psoriasis. Indian J Dermatol Venereol Leprol. 2023;89(3):378–84. https://dx.doi.org/10.25259/IJDVL_1054_2021
- Liu Z.J., Tian Y.T., Shi B.Y., et al. Association between mutation of interleukin 36 receptor antagonist and generalized pustular psoriasis: A PRISMA-compliant systematic review and metaanalysis. Medicine (Baltimore). 2020;99(45):e23068. https://dx.doi.org/10.1097/MD.0000000000023068
- Boutet M.A., Nerviani A., Pitzalis C. IL-36, IL-37, and IL-38 cytokines in skin and joint inflammation: a comprehensive review of their therapeutic potential. Int J Mol Sci. 2019;20(6):1257. https://dx.doi.org/10.3390/ijms20061257
- Sugiura K. Role of interleukin 36 in generalised pustular psoriasis and beyond. Dermatol Ther (Heidelb). 2022;12(2):315–28. https://dx.doi.org/10.1007/s13555-021-00677-8
- Zheng M., Jullien D., Eyerich K. The prevalence and disease characteristics of generalized pustular psoriasis. Am J Clin Dermatol. 2022;23(Suppl. 1):5–12. https://dx.doi.org/10.1007/s40257-021-00664-x
- Rivera-Díaz R., Daudén E., Carrascosa J.M., et al. Generalized Pustular Psoriasis: A Review on Clinical Characteristics, Diagnosis, and Treatment Dermatol Ther (Heidelb). 2023;13(3):673–88. https://dx.doi.org/10.1007/s13555-022-00881-0
- Choon S.E., Navarini A.A., Pinter A. Clinical course and characteristics of generalized pustular psoriasis. Am J Clin Dermatol. 2022;23(Suppl. 1):21–9. https://dx.doi.org/10.1007/s40257-021-00654-z
- Reynolds K.A., Pithadia D.J., Lee E.B., et al. Generalized pustular psoriasis: a review of the pathophysiology, clinical manifestations, diagnosis, and treatment. Cutis. 2022;110(Suppl. 2):19–25. https://dx.doi.org/10.12788/cutis.0579
- Iznardo H., Puig L. The interleukin-1 family cytokines in psoriasis: pathogenetic role and therapeutic perspectives. Expert Rev Clin Immunol. 2021;17(2):187–99. https://dx.doi.org/10.1080/1744666X.2021.1886081
- Fujita H., Terui T., Hayama K., et al. Japanese guidelines for the management and treatment of generalized pustular psoriasis: the new pathogenesis and treatment of GPP. J Dermatol. 2018;45(11):1235–70. https://dx.doi.org/10.1111/1346-8138.14523
- Burden A.D., Choon S.E., Gottlieb A.B., et al. Clinical disease measures in generalized pustular psoriasis. Am J Clin Dermatol. 2022;23(Suppl. 1):39–50. https://dx.doi.org/10.1007/s40257-021-00653-0
- Krueger J., Puig L., Thaci D. Treatment options and goals for patients with generalized pustular psoriasis. Am J Clin Dermatol. 2022;23(Suppl. 1):51–64. https://dx.doi.org/10.1007/s40257-021-00658-9
- Saek H., Terui T., Morita A., et al. Japanese guidance for use of biologics for psoriasis (the 2019 version). J Dermatol. 2020;47:201–22. https://dx.doi.org/10.1111/1346-8138.15196
- Wilsmann-Theis D., Schnell L.M., Ralser-Isselstein V., et al. Successful treatment with interleukin17A antagonists of generalized pustular psoriasis in patients without IL-36RN mutations. Dermatol. 2018;45(7):850–4. https://dx.doi.org/10.1111/1346-8138.14318
- Miao C., Chen Y., Wang Z., et al. Real-world data on the use of secukinumab and acitretin in pediatric generalized pustular psoriasis. J Dermatol. 2023;50(2):258–61. https://dx.doi.org/10.1111/1346-8138.16551
- Lopez-Sanchez C., Falla L.M., Roé-Crespo E., et al. Excellent response to secukinumab in an infant with severe generalized pustular psoriasis. J Dermatol. 2021;48 (6):907–10. https://dx.doi.org/10.1111/1346-8138.15673
- Владимирова Е.В., Мураков С.В., Маркова Ю.А. и др. Острый генерализованный пустулезный псориаз (тип Цумбуша): успешное лечение без использования биологических препаратов. Клиническая дерматология и венерология 2023;22(1):26–32. [Vladimirova E.V., Murakov S.V., Markova Yu.A. et al. Acute generalized pustular psoriasis (Zumbusch type): successful treatment without the use of biological drugs. Rus J Clin Dermatol Venereol. 2023;22(1):26–32. (In Russ.)]. https://dx.doi.org/10.17116/klinderma20232201126
- Armstrong A.W., Elston C.A., Elewski B.E., et al. Generalized Pustular Psoriasis: A Consensus Statement from the National Psoriasis Foundation. J Am Acad Dermatol. 2024;90(4):727–30. https://dx.doi.org/10.1016/j.jaad.2023.09.080
- Bellali T., Karamitri I. The Delphi research methodology and its applications in the healthcare sciences. Arch Hellen Med. 2011;28(6):839-848.
- Odorici G., Di Lernia V., Bardazzi F., et al. Psoriasis and pregnancy outcomes in biological therapies: a real-life, multi-centre experience. J Eur Acad Dermatol Venereol. 2019;33:374–7. https://dx.doi.org/10.1111/jdv.15671
- Imafuku S., Honma M., Okubo Y., et al. Efficacy and safety of secukinumab in patients with generalized pustular psoriasis: A 52-week analysis from phase III open-label multicenter Japanese study. J Dermatol. 2016;43(9):1011–17. https://dx.doi.org/10.1111/1346-8138.13306.
- Zhang J., Xia P., Wan L., et al. Generalized pustular psoriasis of pregnancy successfully treated with secukinumab. Indian J Dermatol Venereol Leprol. 2023;89(6):886–8. https://dx.doi.org/10.25259/IJDVL_1060_2022
- Baum P., Visvanathan S., Garcet S., et al. Pustular psoriasis: molecular pathways and effects of spesolimab in generalized pustular psoriasis. J Allergy Clin Immunol. 2022;149(4):1402–12. https://dx.doi.org/10.1016/j.jaci.2021.09.035.
- Langley R., Elewski B.E., Lebwohl M., et al. Secukinumab in plaque psoriasis–results of two phase 3 trials. N Engl J Med. 2014;371(4):326–38. https://dx.doi.org/10.1056/NEJMoa1314258
- Wasilewska A., Winiarska M., Olszewska M., et al. Interleukin-17 inhibitors. A new era in treatment of psoriasis and other skin diseases. Adv Dermatol Allergol. 2016;33(4):247–52. https://dx.doi.org/10.5114/ada.2016.61599
- Strober B., Gottlieb A.B., Sherif B., et al. Secukinumab sustains early patient-reported outcome benefits through 1 year: Results from 2 phase III randomized placebo-controlled clinical trials comparing secukinumab with etanercept. J Am Acad Dermatol. 2017;76(4):655–61. https://dx.doi.org/10.1016/j.jaad.2016.11.043
Supplementary files
