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Treatment of acute pustular psoriasis

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Treatment

Patients with erythrodermic or generalised pustular psoriasis often require admission to the hospital and use of systemic therapy from the outset (1,2,3).

Disease-specific medications include systemic retinoids (acitretin, isotretinoin), methotrexate, cyclosporine, and infliximab (3)

  • methotrexate and cyclosporin usually provide the most rapid response (1,2)
    • 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 (3).

Second line options (3):

  • 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.

Reference:


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