We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Observation |

Acute Generalized Pustular Psoriasis Treated With the IL-17A Antibody Secukinumab

Alexander Böhner, MD1; Sophie Roenneberg, MD1; Kilian Eyerich, MD, PhD1; Bernadette Eberlein, MD1; Tilo Biedermann, MD1
[+] Author Affiliations
1Department of Dermatology and Allergy Biederstein, Technical University Munich, Munich, Germany
JAMA Dermatol. 2016;152(4):482-484. doi:10.1001/jamadermatol.2015.4686.
Text Size: A A A
Published online


This case report describes rapid improvement of acute generalized pustular psoriasis treated with the interleukin 17A antibody secukinumab.

We describe a patient with acute generalized pustular psoriasis (GPP) treated with the new anti–interleukin (IL)-17A antibody, secukinumab, who showed a remarkable response with almost complete resolution of pustulation after the first injection. To our knowledge, there are no data in the literature evaluating the efficacy of secukinumab in GPP.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption
Figure 1.
A Case of Severe Pustular Psoriasis in a Middle-Aged Man

Clinical images of the upper leg before (A) and 7 days after (B) the first injection of secukinumab.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Laboratory and Clinical Response to Secukinumab

Quantitative laboratory (A) and clinical (B) parameters over the course of therapy. BSA indicates body surface area; CRP, C-reactive protein; GPPASI, generalized pustular psoriasis area and severity index; and WBC, white blood cell count.

Graphic Jump Location




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment
A Case to Support the Use of IL-17A inhibitors for Acute Generalized Pustular Psoriasis
Posted on June 8, 2016
Ludi Ge, Patricia Lowe
Dermatology Department, Royal Prince Alfred Hospital
Conflict of Interest: None Declared
We read with interest the case by Bohner et al 1 . We report a similar case of a 37-

year-old female admitted with acute generalized pustular psoriasis (GPP) who

responded rapidly to the new anti-interluekin- 17a inhibitor, secukinumab. Our

patient presented tachycardic with widespread pustules coalescing to forms

lakes of pus and erythema covering more than 70% body surface area, on the

background of recent prednisone cessation for a respiratory condition. Similarly

to Bohner et al 1 , our patient had a striking response 48 hours after the first dose

of secukinumab (300mg), with a marked reduction in erythema and pustules.

The patient received weekly dosing for the first 5 weeks, and then monthly

dosing. There was a complete clearance of pustular psoriasis by day 14, and

interestingly, our patient did not experience any relapses as described by Bohner

et al 1 .

We theorize that the neutrophilic infiltration of GPP explains the rapid clinical

response to secukinumab. Reich et al 2 showed that dermal neutrophils in chronic

plaque psoriasis treated with secukinumab were almost entirely cleared by

Week 2. This histopathological timeframe parallels the clearance of GPP by day

14 in our case. Our case supports the use of IL-17A inhibitors for GPP.

1. Bohner A, Roenneberg S, Eyerich K, et al. Acute Generalized Pustular Psoriasis

Treated with the IL-17A Antibody Secukinumab. JAMA Dermatology.


2. Reich K, Papp K, Matheson R, et al. Evidence that a neutrophil-keratinocyte

crosstalk is an early target of IL-17A inhibition in psoriasis. Experimental

Dermatology. 2015;24:529-535
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles