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

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Supplementary files

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

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2. 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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3. 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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