Successful response in a case of severe pustular psoriasis after IL-1β inhibition.

ΤίτλοςSuccessful response in a case of severe pustular psoriasis after IL-1β inhibition.
Publication TypeJournal Article
Year of Publication2016
AuthorsSkendros P, Papagoras C, Lefaki I, Giatromanolaki A, Kotsianidis I, Speletas M, Bocly V, Theodorou I, Dalla V, Ritis K
JournalThe British journal of dermatology
Date Published2016 Apr 23
ISSN0007-0963
Abstract

Generalized pustular psoriasis (GPP) is a severe type of psoriasis accompanied by systemic and often life-threatening manifestations. The efficacy of the IL-1 antagonist anakinra in cases of GPP underscores the role of IL-1 in disease pathogenesis. We present a case of a middle-aged man who developed an abrupt and severe form of GPP with severe eosinophilia and cholestatic hepatitis. The patient received salvage treatment with a combination of glucocorticoids, hydroxyurea and imatinib, while administration of the IL-1 inhibitor anakinra resulted in remission of hepatitis and a signifigant skin improvement. However, due to persistent hypersensitivity skin reactions, anakinra was withdrawn and replaced with the anti-IL-1β antagonist canakinumab. As a result of canakinumab, the patient's skin completely cleared, while no systemic manifestations recurred. After one year of continuous canakinumab therapy, the patient remained virtually free of symptoms, while the drug was well tolerated. Generalized pustular psoriasis (GPP) is a severe type of psoriasis characterized by widespread erythema, pustulation and systemic, potentially life-threatening complications.(1) We describe a patient with severe GPP with marked eosinophilia complicated by cholestatic hepatitis, who initially received rescue therapy with glucocorticoids, hydroxyurea, imatinib and the IL-1 receptor antagonist anakinra, while he finally experienced complete and sustained response to the anti-IL-1β monoclonal antibody canakinumab. This article is protected by copyright. All rights reserved.

URLhttp://dx.doi.org/10.1111/bjd.14685
DOI10.1111/bjd.14685
Short TitleBr J Dermatol