Serious generalized pustular psoriasis with evolution to plaque psoriasis: approach with spesolimab

Liz S. Gea, Department of Dermatology, Hospital de Base, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil Julia C. K. El Dib, Department of Dermatology, Hospital de Base, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil Omar Algazal, Department of Dermatology and Department of Pathology, Hospital de Base, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil Eduardo C.N. Constantino, Department of Pathology, Hospital de Base, Faculdade de Medicina de São José do Rio Preto. São José do Rio Preto, São Paulo, Brazil Vera L. A. Nasser, Department of Dermatology and Department of Pathology, Hospital de Base, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil João R. Antonio, Department of Dermatology and Department of Pathology, Hospital de Base, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil

Generalized pustular psoriasis (GPP) is characterized by an acute and severe variant of psoriasis, often accompanied by systemic symptoms, with the eruption of multiple sterile pustules over an area of erythema, associated or not with the form of plaque psoriasis. Epidemiological data on disease are limited, but a global prevalence is estimated at around 1-7 cases per million people, affecting mainly females, with a higher incidence in the fourth and fifth decades of life. Exacerbations are marked by varying degrees of inflammation and systemic symptoms and have an unpredictable evolution. Hyperactivity of the interleukin-36 (IL-36) inflammatory pathway was discovered as the main pathway responsible for causing the disease. Recently, the active substance spesolimab has shown excellent results in the treatment of GPP, with a mechanism of blocking IL-36 receptor activation, leading to the suppression of pro-inflammatory and profibrotic pathways in inflammatory skin and intestinal diseases.

Keywords: Psoriasis. Pustular psoriasis. Generalized pustular psoriasis. Plaque psoriasis. Spesolimab. Anti interleukin-36.