Skip to main content
SpringerLink
Log in

Generalized Pustular Psoriasis in Pregnancy: Current and Future Treatments

  • Review Article
  • Published:
American Journal of Clinical Dermatology Aims and scope Submit manuscript

Abstract

Generalized pustular psoriasis (GPP) is a rare, severe neutrophilic skin disease characterized by sudden widespread eruption of sterile pustules with or without systemic symptoms. GPP may be life threatening in cases with severe complications such as cardiovascular failure, acute respiratory distress syndrome, and serious infections. Impetigo herpetiformis (IH) is a GPP that is induced and exacerbated by pregnancy and occurs most frequently during the last trimester. IH may result in poor or fatal neonatal outcomes, including placental insufficiency, fetal abnormalities, stillbirth, and early neonatal death. Most patients have prompt remission in the postpartum period; however, earlier appearance and more severe symptoms are observed during subsequent pregnancies. Appropriate treatment and close monitoring of the mother and fetus are vital for the management of patients with IH. Particular attention is required for the management of patients with IH to avoid an influence on the fetus. However, data regarding treatments for GPP in pregnant women are sparse. Over the last decade, many patients with IH have been treated with cyclosporine, corticosteroids, tumor necrosis factor-α inhibitors, interleukin (IL)-17 and IL-12/23 inhibitors, and granulocyte and monocyte adsorption apheresis (GMA). GMA may be an important option for patients with IH as it is presently one of the safest available therapeutic options, but there have been no reports to fully confirm its safety in pregnant patients with GPP. Alternatively, based on recent advances in the understanding of the role of the IL-36 axis in the pathogenesis of GPP, biologic agents that target the IL-36 pathway may demonstrate promising efficacy in IH.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Menter A, Van Voorhees AS, Hsu S. Pustular psoriasis: a narrative review of recent developments in pathophysiology and therapeutic options. Dermatol Ther (Heidelb). 2021;11:1917–29.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Genovese G, Moltrasio C, Cassano N, Maronese CA, Vena GA, Marzano AV. Pustular psoriasis: from pathophysiology to treatment. Biomedicines. 2021;9:1746.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Benjegerdes KE, Hyde K, Kivelevitch D, Mansouri B. Pustular psoriasis: pathophysiology and current treatment perspectives. Psoriasis (Auckl). 2016;6:131–44.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Wang H, Jin H. Update on the aetiology and mechanisms of generalized pustular psoriasis. Eur J Dermatol. 2021;31:602–8.

    Article  CAS  PubMed  Google Scholar 

  5. Collamer AN, Battafarano DF. Psoriatic skin lesions induced by tumor necrosis factor antagonist therapy: clinical features and possible immunopathogenesis. Semin Arthritis Rheum. 2010;40(3):233–40.

    Article  CAS  PubMed  Google Scholar 

  6. Dai Y-X, Chen C-C. Flare-up of pustular psoriasis after ustekinumab therapy: case report and literature review. Dermatol Sin. 2018;36:222–5.

    Article  Google Scholar 

  7. Namazi N, Dadkhahfar S. Impetigo herpetiformis: review of pathogenesis, complication, and treatment. Dermatol Res Pract. 2018;2018:5801280.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Trivedi MK, Vaughn AR, Murase JE. Pustular psoriasis of pregnancy: current perspectives. Int J Womens Health. 2018;10:109–15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Vena GA, Cassano N, Bellia G, Colombo D. Psoriasis in pregnancy: challenges and solutions. Psoriasis (Auckl). 2015;5:83–95.

    CAS  PubMed  PubMed Central  Google Scholar 

  10. Sugiura K, Takemoto A, Yamaguchi M, Takahashi H, Shoda Y, Mitsuma T, et al. The majority of generalized pustular psoriasis without psoriasis vulgaris is caused by deficiency of interleukin-36 receptor antagonist. J Investig Dermatol. 2013;133(11):2514–21.

    Article  CAS  PubMed  Google Scholar 

  11. Kinoshita M, Ogawa Y, Takeichi T, Okamoto T, Osada A, Shimada S, et al. Impetigo herpetiformis with IL-36RN mutation successfully treated with secukinumab. Eur J Dermatol. 2018;28(3):381–2.

    Article  PubMed  Google Scholar 

  12. Ogrum A, Takci Z, Seckin HY, Cetin E. Treatment resistant impetigo herpetiformis treated with infliximab. Dermatol Ther. 2019;32(2): e12839.

    Article  PubMed  Google Scholar 

  13. Yamashita T, Hamada T, Maruta Y, Kajita A, Hirai Y, Morizane S, et al. An effective and promising treatment with adalimumab for impetigo herpetiformis with postpartum flare-up. Int J Dermatol. 2019;58(3):350–3.

    Article  PubMed  Google Scholar 

  14. Kondo RN, Araújo FM, Pereira AM, Lopes VC, Martins LM. Pustular psoriasis of pregnancy (impetigo herpetiformis)—case report. An Bras Dermatol. 2013;88(6 Suppl 1):186–9.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Iwasaki A, Kawakami H, Okubo Y. Granulocyte/monocyte adsorption apheresis as a novel therapeutic approach in the treatment of an impetigo herpetiformis case. Ther Apher Dial. 2018;22(4):414–6.

    Article  PubMed  Google Scholar 

  16. Chhabra G, Chanana C, Verma P, Saxena A. Impetigo herpetiformis responsive to secukinumab. Dermatol Ther. 2019;32(5): e13040.

    Article  PubMed  Google Scholar 

  17. Mohaghegh F, Galehdari H, Rezaie M. Pustular psoriasis of pregnancy in early first trimester: a case report. Clin Case Rep. 2021;9(7): e04438.

    PubMed  PubMed Central  Google Scholar 

  18. Fujita H, Terui T, Hayama K, Akiyama M, Ikeda S, Mabuchi T, et al. Japanese guidelines for the management and treatment of generalized pustular psoriasis: the new pathogenesis and treatment of GPP. J Dermatol. 2018;45:1235–70.

    Article  PubMed  Google Scholar 

  19. Navarini AA, Burden AD, Capon F, Mrowietz U, Puig L, Köks S, et al. European consensus statement on phenotypes of pustular psoriasis. J Eur Acad Dermatol Venereol. 2017;31:1792–9.

    Article  CAS  PubMed  Google Scholar 

  20. Halevy S, Kardaun SH, Davidovici B, Wechsler J. EuroSCAR and RegiSCAR study group. The spectrum of histopathological features in acute generalized exanthematous pustulosis: a study of 102 cases. Br J Dermatol. 2010;163:1245–52.

    Article  CAS  PubMed  Google Scholar 

  21. Feldmeyer L, Heidemeyer K, Yawalkar N. Acute generalized exanthematous pustulosis: pathogenesis, genetic background, clinical variants and therapy. Int J Mol Sci. 2016;17:1214.

    Article  PubMed Central  CAS  Google Scholar 

  22. Navarini AA, Valeyrie-Allanore L, Setta-Kaffetzi N, Barker JN, Capon F, Creamer D, et al. Rare variations in IL36RN in severe adverse drug reactions manifesting as acute generalized exanthematous pustulosis. J Investig Dermatol. 2013;133:1904–7.

    Article  CAS  PubMed  Google Scholar 

  23. Navarini AA, Simpson MA, Borradori L, Yawalkar N, Schlapbach C. Homozygous missense mutation in IL36RN in generalized pustular dermatosis with intraoral involvement compatible with both AGEP and generalized pustular psoriasis. JAMA Dermatol. 2015;151:452–3.

    Article  PubMed  Google Scholar 

  24. Rogel-Vence M, González-Ruiz L, Santiago Sánchez-Mateos JL. Annular pustular psoriasis. Med Clin. 2020;155:326.

    Article  Google Scholar 

  25. Twelves S, Mostafa A, Dand N, Burri E, Farkas K, Wilson R, et al. Clinical and genetic differences between pustular psoriasis subtypes. J Allergy Clin Immunol. 2019;143:1021–6.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Bachelez H, Choon SE, Marrakchi S, Burden AD, Tsai TF, Morita A, et al. Inhibition of the interleukin-36 pathway for the treatment of generalized pustular psoriasis. N Engl J Med. 2019;380:981–3.

    Article  PubMed  Google Scholar 

  27. Choon SE, Lebwohl MG, Marrakchi S, Burden AD, Tsai TF, Morita A, et al. Study protocol of the global Effisayil 1 Phase II, multicentre, randomised, double-blind, placebo-controlled trial of spesolimab in patients with generalized pustular psoriasis presenting with an acute flare. BMJ Open. 2021;11(3): e043666.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Komine M, Morita A. Generalized pustular psoriasis: current management status and unmet medical needs in Japan. Expert Rev Clin Immunol. 2021;17(9):1015–27.

    Article  CAS  PubMed  Google Scholar 

  29. Ohnishi H, Kadowaki T, Mizutani Y, Nishida E, Tobita R, Abe N, et al. Genetic background and therapeutic response in generalized pustular psoriasis patients treated with granulocyte and monocyte adsorption apheresis. Eur J Dermatol. 2018;28:108–11.

    CAS  PubMed  Google Scholar 

  30. Samotij D, Szczęch J, Reich A. Generalized pustular psoriasis: divergence of innate and adaptive immunity. Int J Mol Sci. 2021;22(16):9048.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Hussain S, Berki DM, Choon S-E, Burden AD, Allen MH, Arostegui JI, et al. IL36RN mutations define a severe autoinflammatory phenotype of generalized pustular psoriasis. J Allergy Clin Immunol. 2015;135(4):1067-1070.e9.

    Article  CAS  PubMed  Google Scholar 

  32. Wang T-S, Chiu H-Y, Hong J-B, Chan C-C, Lin S-J, Tsai T-F. Correlation of IL36RN mutation with different clinical features of pustular psoriasis in Chinese patients. Arch Dermatol Res. 2016;308(1):55–63.

    Article  CAS  PubMed  Google Scholar 

  33. Liu ZJ, Tian YT, Shi BY, Zhou Y, Jia XS. Association between mutation of interleukin 36 receptor antagonist and generalized pustular psoriasis: a PRISMA-compliant systematic review and meta-analysis. Medicine. 2020;99: e23068.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Mössner R, Wilsmann-Theis D, Oji V, Gkogkolou P, Löhr S, Schulz P, et al. The genetic basis for most patients with pustular skin disease remains elusive. Br J Dermatol. 2018;178:740–8.

    Article  PubMed  CAS  Google Scholar 

  35. Marrakchi S, Guigue P, Renshaw BR, Puel A, Pei XY, Fraitag S, et al. Interleukin-36-receptor antagonist deficiency and generalized pustular psoriasis. N Engl J Med. 2011;365:620–8.

    Article  CAS  PubMed  Google Scholar 

  36. Onoufriadis A, Simpson MA, Pink AE, Di Meglio P, Smith CH, Pullabhatla V, et al. Mutations in IL36RN/IL1F5 are associated with the severe episodic inflammatory skin disease known as generalized pustular psoriasis. Am J Hum Genet. 2011;89:432–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Yoshikawa M, Rokunohe D, Kimura A, Takahashi M, Korekawa A, Nakajima K, et al. Significance of IL36RN mutation analyses in the management of impetigo herpetiformis: a case report and review of published cases. J Dermatol. 2021;48:699–702.

    Article  CAS  PubMed  Google Scholar 

  38. Sugiura K, Muto M, Akiyama M. CARD14 c.526G>C (p.Asp176His) is a significant risk factor for generalized pustular psoriasis with psoriasis vulgaris in the Japanese cohort. J Investig Dermatol. 2014;134(6):1755–7.

    Article  CAS  PubMed  Google Scholar 

  39. Fujii K, Takahashi T, Matsuyama K, Fujii A, Mizutani Y, Ohnishi H, et al. Impetigo herpetiformis with a CARD14 Thr79Ile variant successfully treated with granulocyte and monocyte adsorption apheresis. J Dermatol. 2020;47(3):e84–5.

    PubMed  Google Scholar 

  40. Akiyama M, Takeichi T, McGrath JA, Sugiura K. Autoinflammatory keratinization diseases: an emerging concept encompassing various inflammatory keratinization disorders of the skin. J Dermatol Sci. 2018;90:105–11.

    Article  CAS  PubMed  Google Scholar 

  41. Mahil SK, Twelves S, Farkas K, Setta-Kaffetzi N, Burden AD, Gach JE, et al. AP1S3 mutations cause skin autoinflammation by disrupting keratinocyte autophagy and up-regulating IL-36 production. J Investig Dermatol. 2016;136:2251–9.

    Article  CAS  PubMed  Google Scholar 

  42. Frey S, Sticht H, Wilsmann-Theis D, Gerschütz A, Wolf K, Löhr S, et al. Rare loss-of-function mutation in SERPINA3 in generalized pustular psoriasis. J Investig Dermatol. 2020;140:1451–5.

    Article  CAS  PubMed  Google Scholar 

  43. Zhang Z, Ma Y, Zhang Z, Lin J, Chen G, Han L, et al. Identification of two loci associated with generalized pustular psoriasis. J Investig Dermatol. 2015;135:2132–4.

    Article  CAS  PubMed  Google Scholar 

  44. Vergnano M, Mockenhaupt M, Benzian-Olsson N, Paulmann M, Grys K, Mahil SK, et al. Loss-of-function myeloperoxidase mutations are associated with increased neutrophil counts and pustular skin disease. Am J Hum Genet. 2020;107:539–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Xiao H, Guo X, Hu B, Liu J, Zhao S, Xu Z, et al. Generalized pustular psoriasis in patients with interferon gamma (IFN-γ) receptor deficiency and mycobacterial infection. J Clin Immunol. 2021;41:829–33.

    Article  CAS  PubMed  Google Scholar 

  46. Murrieta-Coxca JM, Rodríguez-Martínez S, Cancino-Diaz ME, Markert UR, Favaro RR, Morales-Prieto DM. IL-36 cytokines: regulators of inflammatory responses and their emerging role in immunology of reproduction. Int J Mol Sci. 2019;20:1649.

    Article  CAS  PubMed Central  Google Scholar 

  47. Ainscough JS, Macleod T, McGonagle D, Brakefield R, Baron JM, Alase A, et al. Cathepsin S is the major activator of the psoriasis-associated proinflammatory cytokine IL-36γ. Proc Natl Acad Sci USA. 2017;114:E2748–57.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Johnston A, Xing X, Wolterink L, Barnes DH, Yin Z, Reingold L, et al. IL-1 and IL-36 are dominant cytokines in generalized pustular psoriasis. J Allergy Clin Immunol. 2017;140:109–20.

    Article  CAS  PubMed  Google Scholar 

  49. Chang SE, Kim HH, Choi JH, Sung KJ, Moon KC, Koh JK. Impetigo herpetiformis followed by generalized pustular psoriasis: more evidence of same disease entity. Int J Dermatol. 2003;42:754–5.

    Article  CAS  PubMed  Google Scholar 

  50. Robinson A, Van Voorhees AS, Hsu S, Korman NJ, Lebwohl MG, Bebo BF Jr, et al. Treatment of pustular psoriasis: from the medical board of the National Psoriasis Foundation. J Am Acad Dermatol. 2012;67:279–88.

    Article  CAS  PubMed  Google Scholar 

  51. Krueger J, Puig L, Thaçi D. Treatment options and goals for patients with generalized pustular psoriasis. Am J Clin Dermatol. 2022;23(Suppl 1):51–64.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Gooderham MJ, Van Voorhees AS, Lebwohl MG. An update on generalized pustular psoriasis. Expert Rev Clin Immunol. 2019;15(9):907–19.

    Article  CAS  PubMed  Google Scholar 

  53. Luewan S, Sirichotiyakul S, Tongsong T. Recurrent impetigo herpetiformis successfully treated with methotrexate: a case report. J Obstet Gynaecol Res. 2011;37(6):661–3.

    Article  PubMed  Google Scholar 

  54. Jeon C, Nakamura M, Sekhon S, Yan D, Wu JJ, Liao W, et al. Generalized pustular psoriasis treated with apremilast in a patient with multiple medical comorbidities. JAAD Case Rep. 2017;3(6):495–7.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Imafuku S, Honma M, Okubo Y, Komine M, Ohtsuki M, Morita A, et al. Efficacy and safety of secukinumab in patients with generalized pustular psoriasis: a 52-week analysis from phase III open-label multicenter Japanese study. J Dermatol. 2016;43:1011–7.

    Article  CAS  PubMed  Google Scholar 

  56. Saeki H, Nakagawa H, Nakajo K, Ishii T, Morisaki Y, Aoki T, et al. Efficacy and safety of ixekizumab treatment for Japanese patients with moderate to severe plaque psoriasis, erythrodermic psoriasis and generalized pustular psoriasis: results from a 52-week, open-label, phase 3 study (UNCOVER-J). J Dermatol. 2017;44:355–62.

    Article  CAS  PubMed  Google Scholar 

  57. Yamasaki K, Nakagawa H, Kubo Y, Ootaki K, Japanese Brodalumab Study Group. Efficacy and safety of brodalumab in patients with generalized pustular psoriasis and psoriatic erythroderma: results from a 52-week, open-label study. Br J Dermatol. 2017;176:741–51.

    Article  CAS  PubMed  Google Scholar 

  58. Kromer C, Loewe E, Schaarschmidt ML, Pinter A, Gerdes S, Herr R, et al. Drug survival in the treatment of generalized pustular psoriasis: a retrospective multicenter study. Dermatol Ther. 2021;34(2): e14814.

    Article  CAS  PubMed  Google Scholar 

  59. Ikeda S, Takahashi H, Suga Y, et al. Therapeutic depletion of myeloid lineage leukocytes in patients with generalized pustular psoriasis indicates a major role for neutrophils in the immunopathogenesis of psoriasis. J Am Acad Dermatol. 2013;68:609–17.

    Article  CAS  PubMed  Google Scholar 

  60. Shukuya R, Hasegawa T, Niwa Y, Okuma K, Ikeda S. Granulocyte and monocyte adsorption apheresis for generalized pustular psoriasis. J Dermatol. 2011;38:1130–4.

    Article  PubMed  Google Scholar 

  61. Fujisawa T, Moriya C, Shibuya Y, Kanoh H, Seishima M. Combination therapy of infliximab and granulocyte/monocyte adsorption apheresis for refractory pustular psoriasis with psoriatic arthritis. Acta Derm Venereol. 2013;93:364–5.

    Article  PubMed  Google Scholar 

  62. Sugiura K, Haruna K, Suga Y, Akiyama M. Generalized pustular psoriasis caused by deficiency of interleukin-36 receptor antagonist successfully treated with granulocyte and monocyte adsorption apheresis. J Eur Acad Dermatol Venerol. 2014;28:1835–6.

    Article  CAS  Google Scholar 

  63. Kanekura T, Hiraishi K, Kawahara K, Maruyama I, Kanzaki T. Granulocyte and monocyte adsorption apheresis (GCAP) for refractory skin diseases caused by activated neutrophils and psoriatic arthritis: evidence that GCAP removes Mac-1-expressing neutrophils. Ther Apher Dial. 2006;10:247–56.

    Article  CAS  PubMed  Google Scholar 

  64. Patsatsi A, Theodoridis TD, Vavilis D, Tzevelekis V, Kyriakou A, Kalabalikis D, et al. Cyclosporine in the management of impetigo herpetiformis: a case report and review of the literature. Case Rep Dermatol. 2013;5(1):99–104.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Luan L, Han S, Zhang Z, Liu X. Personal treatment experience for severe generalized pustular psoriasis of pregnancy: two case reports. Dermatol Ther. 2014;27(3):174–7.

    Article  PubMed  Google Scholar 

  66. Flynn A, Burke N, Byrne B, Gleeson N, Wynne B, Barnes L. Two case reports of generalized pustular psoriasis of pregnancy: Different outcomes. Obstet Med. 2016;9(2):55–9.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Iinuma S, Minami-Hori M, Honma M, Ishida-Yamamoto A. Acquired hemophilia A following generalized pustular psoriasis of pregnancy. J Dermatol. 2017;44(12):e324–5.

    Article  PubMed  Google Scholar 

  68. Yao X, Zhang X, Peng M, Wang H, Meng Y, Chen Y. A case of impetigo herpetiformis in which termination of pregnancy was required. J Int Med Res. 2020;48:300060520933811.

    PubMed  Google Scholar 

  69. Ulubay M, Keskin U, Fidan U, Çiçek AF, Çalışkan E, Karaca RE, et al. Case report of a rare dermatosis in pregnancy: impetigo herpetiformis. J Obstet Gynaecol Res. 2015;41(2):301–3.

    Article  PubMed  Google Scholar 

  70. Wamalwa EW. Recurrent impetigo herpetiformis: case report. Pan Afr Med J. 2017;27:219.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Pitch M, Somers K, Scott G, Tausk F, Mercurio MG. A case of pustular psoriasis of pregnancy with positive maternal-fetal outcomes. Cutis. 2018;101(4):278–80.

    PubMed  Google Scholar 

  72. Fiboumi AE, Chiheb S. Impetigo herpetiformis: a rare dermotosis of pregnancy. Pan Afr Med J. 2018;30:273.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Kanatani Y, Shinkuma S, Matsumoto Y, Mitsui Y, Shobatake C, Ogawa K, et al. Recurrence of impetigo herpetiformis carrying compound heterozygous mutations in IL36RN after remission with secukinumab. J Dermatol. 2021. https://doi.org/10.1111/1346-8138.16247.

    Article  PubMed  Google Scholar 

  74. Adachi A, Komine M, Hirano T, Tsuda H, Karakawa M, Murata S, et al. Case of generalized pustular psoriasis exacerbated during pregnancy, successfully treated with infliximab. J Dermatol. 2016;43:1439–40.

    Article  PubMed  Google Scholar 

  75. Babuna Kobaner G, Polat EA. Infliximab for the treatment of recalcitrant generalized pustular psoriasis of pregnancy: report of a challenging case. Dermatol Ther. 2020;33(4): e13571.

    Article  CAS  PubMed  Google Scholar 

  76. Beksac B, Adisen E, Gurer MA. Treatment of generalized pustular psoriasis of pregnancy with infliximab. Cutis. 2021;107(3):E2-5.

    PubMed  Google Scholar 

  77. Fukushima H, Iwata Y, Arima M, Tanaka Y, Sugiura K. Efficacy and safety of treatment with anti-tumor necrosis factor-α drugs for severe impetigo herpetiformis. J Dermatol. 2021;48:207–10.

    Article  CAS  PubMed  Google Scholar 

  78. Mizutani Y, Mizutani YH, Matsuyama K, Kawamura M, Fujii A, Shu E, et al. Generalized pustular psoriasis in pregnancy, successfully treated with certolizumab pegol. J Dermatol. 2020;47(7):e262–3.

    PubMed  Google Scholar 

  79. Saito-Sasaki N, Izu K, Sawada Y, Hino R, Nakano R, Shimajiri S, et al. Impetigo herpetiformis complicated with intrauterine growth restriction treated successfully with granulocyte and monocyte apheresis. Acta Derm Venereol. 2017;97(3):410–1.

    Article  PubMed  Google Scholar 

  80. Mizutani Y, Fujii K, Kawamura M, Inoue M, Mizutani YH, Matsuyama K, et al. Intensive granulocyte and monocyte adsorption apheresis for generalized pustular psoriasis. J Dermatol. 2020;47(11):1326–9.

    Article  CAS  PubMed  Google Scholar 

  81. Liu N, Zhu L, Cheng Y, Yu N, Yi X, Ding Y. Successful treatment of recurrent pustular psoriasis of pregnancy with secukinumab: a case report. Acta Derm Venereol. 2020;100(15):adv00251.

    Article  PubMed  Google Scholar 

  82. Nakai Y, Ashida H, Kajita A, Yokoyama E, Sugiura K, Morizane S. Impetigo herpetiformis successfully treated with brodalumab. J Dermatol. 2021. https://doi.org/10.1111/1346-8138.16285.

    Article  PubMed  Google Scholar 

  83. Andrulonis R, Ferris LK. Treatment of severe psoriasis with ustekinumab during pregnancy. J Drugs Dermatol. 2012;11(10):1240.

    PubMed  Google Scholar 

  84. Alsenaid A, Prinz JC. Inadvertent pregnancy during ustekinumab therapy in a patient with plaque psoriasis and impetigo herpetiformis. J Eur Acad Dermatol Venereol. 2016;30(3):488–90.

    Article  CAS  PubMed  Google Scholar 

  85. Mariette X, Förger F, Abraham B, Flynn AD, Moltó A, Flipo R-M, et al. Lack of placental transfer of certolizumab pegol during pregnancy: results from CRIB, a prospective, postmarketing, pharmacokinetic study. Ann Rheum Dis. 2018;77(2):228–33.

    Article  CAS  PubMed  Google Scholar 

  86. Thatiparthi A, Martin A, Liu J, Egeberg A, Wu JJ. Biologic Treatment algorithms for moderate-to-severe psoriasis with comorbid conditions and special populations: a review. Am J Clin Dermatol. 2021;22(4):425–42.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Iznardo H, Puig L. Exploring the role of IL-36 cytokines as a new target in psoriatic disease. Int J Mol Sci. 2021;22(9):4344.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  88. Viguier M, Guigue P, Pages C, Smahi A, Bachelez H. Successful treatment of generalized pustular psoriasis with the interleukin-1-receptor antagonist anakinra: lack of correlation with IL1RN mutations. Ann Intern Med. 2010;153:66–7.

    Article  PubMed  Google Scholar 

  89. Huffmeier U, Watzold M, Mohr J, Schon MP, Mossner R. Successful therapy with anakinra in a patient with generalized pustular psoriasis carrying IL36RN mutations. Br J Dermatol. 2014;170:202–4.

    Article  CAS  PubMed  Google Scholar 

  90. Mansouri B, Richards L, Menter A. Treatment of two patients with generalized pustular psoriasis with the interleukin-1β inhibitor gevokizumab. Br J Dermatol. 2015;173(1):239–41.

    Article  CAS  PubMed  Google Scholar 

  91. Skendros P, Papagoras C, Lefaki I, Giatromanolaki A, Kotsianidis I, Speletas M, et al. Successful response in a case of severe pustular psoriasis after interleukin-1β inhibition. Br J Dermatol. 2017;176(1):212–5.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Dermatology, Gifu University Graduate School of Medicine, 1-1, Yanagido, Gifu, 501-1194, Japan

    Mariko Seishima, Kento Fujii & Yoko Mizutani

  2. Department of Dermatology, Asahi University Hospital, 3-23, Hashimoto-cho, Gifu, 500-8523, Japan

    Mariko Seishima

Authors
  1. Mariko Seishima
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kento Fujii
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yoko Mizutani
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mariko Seishima.

Ethics declarations

Funding

No sources of funding were used to conduct this study or prepare this manuscript.

Conflicts of interest

Mariko Seishima, Kento Fujii, and Yoko Mizutani have no conflicts of interest that are directly relevant to the content of this article.

Ethics approval

Not applicable.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Availability of data and materials

Not applicable.

Code availability

Not applicable.

Author contributions

MS wrote the first draft of the manuscript. All authors made significant contributions to the concept and planning and approved the final submitted version of the manuscript.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Seishima, M., Fujii, K. & Mizutani, Y. Generalized Pustular Psoriasis in Pregnancy: Current and Future Treatments. Am J Clin Dermatol 23, 661–671 (2022). https://doi.org/10.1007/s40257-022-00698-9

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40257-022-00698-9

Search

Navigation