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Pustular Psoriasis: A Narrative Review of Recent Developments in Pathophysiology and Therapeutic Options

Pustular psoriasis is an unusual form of psoriasis that frequently presents clinical challenges for dermatologists. The condition presents with pustules on an erythematous background and has two distinct subtypes: localized disease on the palms and soles, called palmoplantar pustulosis (PPP), and ge...

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Autores principales: Menter, Alan, Van Voorhees, Abby S., Hsu, Sylvia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Healthcare 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8611132/
https://www.ncbi.nlm.nih.gov/pubmed/34626330
http://dx.doi.org/10.1007/s13555-021-00612-x
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author Menter, Alan
Van Voorhees, Abby S.
Hsu, Sylvia
author_facet Menter, Alan
Van Voorhees, Abby S.
Hsu, Sylvia
author_sort Menter, Alan
collection PubMed
description Pustular psoriasis is an unusual form of psoriasis that frequently presents clinical challenges for dermatologists. The condition presents with pustules on an erythematous background and has two distinct subtypes: localized disease on the palms and soles, called palmoplantar pustulosis (PPP), and generalized pustular psoriasis (GPP). The involvement of the fingers, toes, and nails is defined as a separate localized variant, acrodermatitis continua of Hallopeau, and is now thought to be a subset of PPP. The rarity of pustular psoriasis frequently makes the correct diagnosis problematic. In addition, treatment is limited by a relative lack of evidence-based therapeutic options. Current management is often based on existing therapies for standard plaque psoriasis. However, there remains a need for treatments with high, sustained efficacy and a rapid onset of action in pustular psoriasis. Recent advances in understanding of the pathogenesis of pustular psoriasis have provided insights into potential therapies. Treatment of pustular psoriasis is generally determined by the extent and severity of disease, and recent years have seen an increasing use of newer agents, including biologic therapies. Current classes of biologic therapies with US Food and Drug Administration and European Medicines Agency approval for treatment of moderate-to-severe plaque psoriasis in the USA (and elsewhere) include tumor necrosis factor alpha inhibitors (adalimumab, certolizumab pegol, etanercept, infliximab), interleukin (IL)-17 inhibitors (brodalumab, ixekizumab, secukinumab), an IL-12/23 inhibitor (ustekinumab), and IL-23 inhibitors (guselkumab, risankizumab, tildrakizumab). Recently, specific inhibitors of the IL-36 pathway have been evaluated in GPP and PPP, including spesolimab, an IL-36 receptor inhibitor which has shown promising results in GPP. The emerging drugs for pustular psoriasis offer the possibility of rapid and effective treatment with lower toxicities than existing therapies. Further research into agents acting on the IL-36 pathway and other targeted therapies has the potential to transform the future treatment of patients with pustular psoriasis. This article reviews the clinical features of PPP and GPP, and current understanding of the genetics and immunopathology of these conditions; it also provides an update on emerging treatments. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13555-021-00612-x.
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spelling pubmed-86111322021-12-10 Pustular Psoriasis: A Narrative Review of Recent Developments in Pathophysiology and Therapeutic Options Menter, Alan Van Voorhees, Abby S. Hsu, Sylvia Dermatol Ther (Heidelb) Review Pustular psoriasis is an unusual form of psoriasis that frequently presents clinical challenges for dermatologists. The condition presents with pustules on an erythematous background and has two distinct subtypes: localized disease on the palms and soles, called palmoplantar pustulosis (PPP), and generalized pustular psoriasis (GPP). The involvement of the fingers, toes, and nails is defined as a separate localized variant, acrodermatitis continua of Hallopeau, and is now thought to be a subset of PPP. The rarity of pustular psoriasis frequently makes the correct diagnosis problematic. In addition, treatment is limited by a relative lack of evidence-based therapeutic options. Current management is often based on existing therapies for standard plaque psoriasis. However, there remains a need for treatments with high, sustained efficacy and a rapid onset of action in pustular psoriasis. Recent advances in understanding of the pathogenesis of pustular psoriasis have provided insights into potential therapies. Treatment of pustular psoriasis is generally determined by the extent and severity of disease, and recent years have seen an increasing use of newer agents, including biologic therapies. Current classes of biologic therapies with US Food and Drug Administration and European Medicines Agency approval for treatment of moderate-to-severe plaque psoriasis in the USA (and elsewhere) include tumor necrosis factor alpha inhibitors (adalimumab, certolizumab pegol, etanercept, infliximab), interleukin (IL)-17 inhibitors (brodalumab, ixekizumab, secukinumab), an IL-12/23 inhibitor (ustekinumab), and IL-23 inhibitors (guselkumab, risankizumab, tildrakizumab). Recently, specific inhibitors of the IL-36 pathway have been evaluated in GPP and PPP, including spesolimab, an IL-36 receptor inhibitor which has shown promising results in GPP. The emerging drugs for pustular psoriasis offer the possibility of rapid and effective treatment with lower toxicities than existing therapies. Further research into agents acting on the IL-36 pathway and other targeted therapies has the potential to transform the future treatment of patients with pustular psoriasis. This article reviews the clinical features of PPP and GPP, and current understanding of the genetics and immunopathology of these conditions; it also provides an update on emerging treatments. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13555-021-00612-x. Springer Healthcare 2021-10-09 /pmc/articles/PMC8611132/ /pubmed/34626330 http://dx.doi.org/10.1007/s13555-021-00612-x Text en © The Author(s) 2021 https://creativecommons.org/licenses/by-nc/4.0/Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Review
Menter, Alan
Van Voorhees, Abby S.
Hsu, Sylvia
Pustular Psoriasis: A Narrative Review of Recent Developments in Pathophysiology and Therapeutic Options
title Pustular Psoriasis: A Narrative Review of Recent Developments in Pathophysiology and Therapeutic Options
title_full Pustular Psoriasis: A Narrative Review of Recent Developments in Pathophysiology and Therapeutic Options
title_fullStr Pustular Psoriasis: A Narrative Review of Recent Developments in Pathophysiology and Therapeutic Options
title_full_unstemmed Pustular Psoriasis: A Narrative Review of Recent Developments in Pathophysiology and Therapeutic Options
title_short Pustular Psoriasis: A Narrative Review of Recent Developments in Pathophysiology and Therapeutic Options
title_sort pustular psoriasis: a narrative review of recent developments in pathophysiology and therapeutic options
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8611132/
https://www.ncbi.nlm.nih.gov/pubmed/34626330
http://dx.doi.org/10.1007/s13555-021-00612-x
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