Is psoriasis therapy an art based on experience?

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Abstract

Psoriasis is a chronic immune-associated skin disease of a multifactorial nature with phenotypic diversity in the general population, as well as a large number of comorbid diseases in patients. The generalized pustular psoriasis, historically was considered one of the variants of the course of psoriasis. Today some authors classify it as a genetically different condition combined with a plaque psoriasis. The selected tactics of psoriasis therapy can become a trigger for the manifestation of a pustular form. Despite the availability of modern data on the immunopathogenesis of the disease, there are no standardized methods of treatment that can take into account the individual characteristics of patients, which is doubly important in pediatric practice, since the arsenal of drugs approved for use is limited. We demonstrate the clinical case of a patient with progressive plaque psoriasis, earlier getting systemic and topical corticosteroids for a long time. This therapy did not allowed to take the course of the disease under control, even more it caused appearance of complications. Our clinical example from practice allows us to focus on the problem of complications of classical therapy for psoriasis and the intricacies of prescribing both topical and systemic drugs. Systemic therapy requires the development of algorithms based on objective diagnostic criteria and the results of studies on the effectiveness and safety of modern drugs in pediatric practice.

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About the authors

Denis V. Zaslavsky

St. Petersburg State Pediatric Medical University

Author for correspondence.
Email: Venereology@gmail.com
ORCID iD: 0000-0001-5936-6232
SPIN-code: 5832-9510

MD, PhD, Dr. Sci. (Med.), Professor, Department of Dermatovenereology

Russian Federation, Saint Petersburg

Igor N. Chuprov

St. Petersburg State North-Western Medical University named after I.I. Mechnikov

Email: Igorchuprov@gmail.com
SPIN-code: 2423-6196

MD, PhD, Dr. Sci. (Med.), Professor, Department of the Pathological Anatomy

Russian Federation, Saint Petersburg

Ruslan A. Nasyrov

St. Petersburg State Pediatric Medical University

Email: rrmd@mail.ru
ORCID iD: 0000-0001-8120-2816
SPIN-code: 5446-0950

MD, PhD, Dr. Sci. (Med.), Professor, Head, Department of Pathological Anatomy with a Course of Forensic Medicine

Russian Federation, Saint Petersburg

Olga L. Krasnogorskaya

St. Petersburg State Pediatric Medical University

Email: krasnogorskaya@yandex.ru
SPIN-code: 2460-4480

MD, PhD, Associate Professor, Department of Pathological Anatomy with a Course of Forensic Medicine

Russian Federation, Saint Petersburg

Elena S. Bolshakova

St. Petersburg State Pediatric Medical University

Email: Bolena2007@rambler.ru

Head, Department of Dermatovenereology

Russian Federation, Saint Petersburg

Elena S. Manylova

St. Petersburg State Pediatric Medical University

Email: Tulechka78@mail.ru

Dermatovenereologist

Russian Federation, Saint Petersburg

Olga K. Mineeva

St. Petersburg State Pediatric Medical University

Email: mine@yandex.ru

Clinical Dermatovenereologist

Russian Federation, Saint Petersburg

Lyudmila N. Drozdova

St. Petersburg State Pediatric Medical University

Email: Luddrozd@mail.ru

Dermatovenereologist

Russian Federation, Saint Petersburg

Ksana V. Shternliht

St. Petersburg State Pediatric Medical University

Email: Sara.shtern70@mail.ru

Pediatrician, Head of the Department, Head of the children reception Department

Russian Federation, Saint Petersburg

Akmal A. Sidikov

Fergana Medical Institute of Public Health

Email: Medik-85@bk.ru
ORCID iD: 0000-0002-0909-7588
SPIN-code: 3812-8400

MD, PhD, Dr. Sci. (Med.), Professor, Rector

Uzbekistan, Fergana

Kseniya A. Kovalenko

St. Petersburg State Pediatric Medical University

Email: Zgbv00@mail.ru
SPIN-code: 4466-9583

Student, Department of the Dermatovenereology

Russian Federation, Saint Petersburg

Alena P. Brazhnikova

St. Petersburg State Pediatric Medical University

Email: Alenapetrovna919@gmail.com
ORCID iD: 0000-0002-9800-7133
SPIN-code: 1791-0736

Dermatovenereologist, Assistant

Russian Federation, Saint Petersburg

Dariya V. Kozlova

St. Petersburg State Pediatric Medical University

Email: Dashaucheneya@yandex.ru
ORCID iD: 0000-0002-6942-2880
SPIN-code: 3783-8565

Student, employee, Department of Dermatovenereology

Russian Federation, Saint Petersburg

References

  1. Baranov AA, Volodin NN, Samsygina GA, et al. Ratsional’naya farmakoterapiya detskikh zabolevanii. Moscow: Litterra; 2007. 1163 p. (In Russ.)
  2. Brazhnikova AP, Paneyzkh MB, Gorlanov IA, et al. Sneddon — Wilkinson subcorneal pustulosis or IgA pemphigus? Farmateka. 2021;28(8):156–161. (In Russ.) doi: 10.18565/pharmateca.2021.8.156-161
  3. Vasiliev AG, ZaslavskyDV, TrashkovAP, et al. Сhanges in the hormonal status of patients with focal psoriasis vulgaris. Vestnik Dermatologii i Venerologii. 2011;5:88–90. (In Russ.)
  4. Gorbunova VN. Molecular genetics – the way to individual personalized medicine. Pediatrician (St. Petersburg) 2013;4(1):115–121. (In Russ.) doi: 10.17816/PED41115-121
  5. Zaslavsky DV, Ravodin RA, Tatarskaya OB, et al. Erythroderma: the modern questions of diagnostics and treatment. Pediatician (St. Petersburg). 2014;5(1):97–102 (In Russ.)
  6. Zaslavskii DV, Kharbediya ShD, Khvedelidze MG, et al. Rezul’taty otsenki patsientami deyatel’nosti meditsinskogo personala. Proceedings of the IX Russian-German Scientific and Practical Conference of the Forum. R. Koch and I.I. Mechnikov “Novye gorizonty: innovatsii i sotrudnichestvo v meditsine i zdravookhranenii”. Kravchenko OV, Khan G, Eds. Novosibirsk: Sibirskii tsenter delovykh tekhnologii; 2010. P. 28–29. (In Russ.)
  7. Kostinov MP, Bulgakova VA, Abaeva ZR, et al. Immunokorrekciya v pediatrii. Moscow: Medicina dlya vsekh; 2001. 237 p. (In Russ.)
  8. Ministerstvo zdravookhraneniya Rossiyskoi Federatsii. Klinicheskie rekomendatsii. Psoriaz u detei i vzroslykh. 2020. 66 p. (In Russ.) Available from: https://bazanpa.ru/minzdrav-rossii-klinicheskie-rekomendatsii-ot01012020-h4782548/
  9. Murashkin NN, Ivanov AM, Zaslavskн DV, Kamilova TA. Studies on effectiveness and safety of system retinoids use in therapy of adolescent acne. Vestnik dermatologii i venerologii. 2010;5:112–116.
  10. Rodionov AN, Zaslavsky DV, Chuprov IN, et al. Dermatopatologiya vospalitelnykh zabolevaniy kozhy. Тashkent: Baktria Press; 2014. 208 p. (In Russ.)
  11. Yuryev VK, Zaslavsky DV, Vitenko NV, et al. Some results of the assessment of patients of the quality of medical care. The Scientific Notes of the Pavlov University. 2010;17(2):5–7. (In Russ.)
  12. Menter A, Cordoro KM, Dawn MR, et al. Joint American Academy of Dermatology – National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis in pediatric patients. J Am Acad Dermatol. 2020:82(1):161–201. doi: 10.1016/j.jaad.2019.08.049
  13. Andrulonis R, Ferris LK. Treatment of severe psoriasis with ustekinumab during pregnancy. J Drugs Dermatol. 2012;11(10):1240.
  14. Bachelez H. Pustular psoriasis: the dawn of a new era. Acta Derm Venereol. 2020;100:adv00034. doi: 10.2340/00015555–3388
  15. Benson JM, Peritt D, Scallon BJ, et al. Discovery and mechanism of ustekinumab: a human monoclonal antibody targeting interleukin-12 and interleukin-23 for treatment of immune-mediated disorders. MAbs. 2011;3(6):535–545. doi: 10.4161/mabs.3.6.17815
  16. Buttgereit F, Da Silva JAP, Boers M, et al. Standardised nomenclature for glucocorticoid dosages and glucocorticoid treatment regimens: current questions and tentative answers in rheumatology. Ann Rheum Dis. 2002;61(8):718–722. doi: 10.1136/ard.61.8.718
  17. Degos R, Civatte J, Arrouy M. Psoriasis et psoriasis pustuleaxatype deerythemeannulaire centrifuge (3 cas). Bull Soc Fr Dermatol Syphiligr. 1966;73(4): 356–358.
  18. Falto-Aizpurua LA, Martin-Garcia RF, CarrasquilloOY, et al. Biological therapy for pustular psoriasis: a systematic review. Int J Dermatol. 2020;59(3):284–296. doi: 10.1111/ijd.14671
  19. Fujita H, Terui T, Hayama K, et al. Japanese guidelines for the management and treatment of generalized pustular psoriasis: the new pathogenesis and treatment of GPP. J Dermatol. 2018;45(11):1235–1270. doi: 10.1111/1346–8138.14523
  20. Goenaga-Vázquez Y, Lauk KC, et al. Therapeutic challenges in managing pediatric psoriasis. Int J Women’s Dermatol. 2020:7(3):314–318. doi: 10.1016/j.ijwd.2020.09.012
  21. Golubnitschaja O, Costigliola V, Benini A, et al. General Report & Recommendations in Predictive, Preventive and Personalised Medicine 2012: White Paper of the European Association for Predictive, Preventive and Personalised Medicine. EPMA J. 2012;3(1):14. doi: 10.1186/1878-5085-3-14
  22. Hussain S, Berki DM, Choon SE, et al. IL36RN mutations define a severe autoinflammatory phenotype of generalized pustular psoriasis. J Allergy Clin Immunol. 2015;135(4):1067–1070. doi: 10.1016/j.jaci.2014.09.043
  23. Karamfilov T, Wollina U. Juvenile generalized pustular psoriasis. Acta Derm Venereol. 1998;78(3):220. doi: 10.1080/000155598441576
  24. Kittler NW, Cordoro KM. Pediatric Psoriasis Comorbidities. Skin Therapy Lett. 2020;25(5):1–6.
  25. Lapiere S. Deux cas de psoriasis recidivants a elements evoluant de faconanoralement: Rapideenquelequesjours. Arch Belg Dermatol Syphiligr. 1959;15(1): 7–12.
  26. Levin EC, Debbaneh M, Koo J, et al. Biologic therapy in erythrodermic and pustular psoriasis. J Drugs Dermatol. 2014;13(3):342–354.
  27. Mansouri B, Richards L, Menter A. Treatment of two patients with generalized pustular psoriasis with the interleukin-1 beta inhibitor gevokizumab. Br J Dermatol. 2015;173(1):239–241. doi: 10.1111/bjd.13614
  28. Mehta AB, Nadkarni NJ, Patil SP, et al. Topical corticosteroids in dermatology. Indian J Dermatol Venereol Leprol. 2016;82(4):371–378. doi: 10.4103/0378-6323.178903
  29. Michalek IM, Loring B, John SM. A systematic review of worldwide epidemiology of psoriasis. J Eur Acad Dermatol Venereol. 2017;31(3):205–212. doi: 10.1111/jdv.13854
  30. Milian A, Katchoura V. Psoriasis pustuleux généralisé. Bull Soc Fr Dermatol Syph. 1933;40:851–853. (In French.)
  31. Navarini AA, Burden AD, Capon F, et al. ERASPEN Network: European consensus statement on phenotypes of pustular psoriasis. J Eur Acad Dermatol Venereol. 2017;31(11):1792–1799. doi: 10.1111/jdv.14386
  32. Neve S, Kirtschig G. Elastotic striae associated with striae distensae after application of very potent topical corticosteroids. Clin Exp Dermatol. 2006;31(3):461–462. doi: 10.1111/j.1365-2230.2006.02090.x
  33. Robinson A, Van Voorhees AS, Hsu S, et al. Treatment of pustular psoriasis: from the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol. 2012;67(2):279–288. doi: 10.1016/j.jaad.2011.01.032
  34. Sfikakis PP, Iliopoulos A, Elezoglou A, et al. Psoriasis induced by anti-tumor necrosis factor therapy: a paradoxical adverse reaction. Arthritis Rheum. 2005;52(8):2513–2518. doi: 10.1002/art.21233
  35. Sussman M, Napodano A, Huang S, et al. Pustular Psoriasis and Acute Generalized Exanthematous Pustulosis. Medicina (Kaunas). 2021;57(10):1004. doi: 10.3390/medicina57101004
  36. Tsuruta D, Ishii N, Hamada T, et al. IgA pemphigus. Clin Dermatol. 2011;29(4):437–442. doi: 10.1016/j.clindermatol.2011.01.014
  37. Uva L, Miguel D, Pinheiro C, et al. Mechanisms of Action of Topical Corticosteroids in Psoriasis. Int J Endocrinol. 2012;2012:561018.
  38. Viguier M, Guigue P, Pages C, et al. Successful treatment of generalized pustular psoriasis with the interleukin-1-receptor antagonist Anakinra: lack of correlation with IL1RN mutations. Ann Int Med. 2010;153(1):66–67. doi: 10.7326/0003-4819-153-1-201007060-00030
  39. Watts PJ, Khachemoune A. Subcorneal pustular dermatosis: a review of 30 years of progress. Am J Clin Dermatol. 2016;17(6):653–671. doi: 10.1007/s40257-016-0202-8
  40. Von Zumbusch L. Psoriasis and pustuloses exanthema. Arch Dermatol Syphilol. 1910;99:335–346.

Supplementary files

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2. Fig. 1. Generalized pustular psoriasis manifested on the background of long-term usage of topical and systemic corticosteroids

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3. Fig. 2. Micrograph, hematoxylin-eosin staining, ×200. There is a regular acantosis in the epidermis (black double arrowheads), agranulosis (white triangles), Munromicroabscess (black arrow), heterogeneous perivascular infiltrate of lymphocytes, histiocytes with an admixture of neutrophils (white arrows) is determined in the papillary and reticular dermis

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4. Fig. 3. Clinical images of the patient after the initiation of biological therapy with interleukin 12 and 23 inhibitor (ustekinumab). Rashes on the skin of the trunk and limbs resolved, PASI 90

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Copyright (c) 2022 Zaslavsky D.V., Chuprov I.N., Nasyrov R.A., Krasnogorskaya O.L., Bolshakova E.S., Manylova E.S., Mineeva O.K., Drozdova L.N., Shternliht K.V., Sidikov A.A., Kovalenko K.A., Brazhnikova A.P., Kozlova D.V.

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