Treatment
Patients with erythrodermic or generalised pustular psoriasis often require admission to the hospital and use of systemic therapy from the outset (1).
Disease-specific medications include systemic retinoids (acitretin, isotretinoin), methotrexate, cyclosporine, and infliximab (2)
- methotrexate and cyclosporin usually provide the most rapid response (1)
- methotrexate can be used
- as a short term treatment method
- to control the disease before starting other methods of treatment
- frequently as long term maintenance treatment method (1)
In the paediatric age group, acitretin, cyclosporine, methotrexate, and etanercept are considered the first line options (1).
Second line options:
- include systemic treatments like etanercept and adalimumab or topical treatments like corticosteroids, calcipotriene, and tacrolimus
- all of these options can be monotherapy choices or in combination with the first line options
- phototherapy is another treatment option
- early delivery is recommended in pregnant patients with impetigo herpetiformis
- there are reports that indicate the successful use of L-1 receptor antagonists (e.g., anakinra) and IL-36 receptor antagonists in treating pustular psoriasis
- tocilizumab, a monoclonal antibody against the IL-6 receptor, has also shown efficacy in some recalcitrant cases of pustular psoriasis
Attention must be given to fluid balance and body temperature.
References:
- van der Kraaij GE, Balak DMW, Busard CI, et al. Highlights of the updated Dutch evidence- and consensus-based guideline on psoriasis 2017. Br J Dermatol. 2019 Jan;180(1):31-42.
- Shah M, Al Aboud DM, Crane JS, et al. Pustular Psoriasis. [Updated 2019 Jul 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-.