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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.
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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.

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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.

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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.

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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.

2016;152(4):482-484

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
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