Successful response in a case of severe pustular psoriasis after interleukin‐1β inhibition

• DOI: 10.1111/bjd.14685
• Publication Date: 2016-04-23T09:04:35Z
• Authors: P. Skendros; C. Papagoras; I. Lefaki; A. Giatromanolaki; I. Kotsianidis; M. Speletas; V. Bocly; I. Theodorou; V. Dalla; K. Ritis
• Keywords: 03 medical and health sciences; 0302 clinical medicine; 3. Good health

Generalized pustular psoriasis (GPP) is a severe type of psoriasis accompanied by systemic and often life-threatening manifestations. The efficacy of the interleukin (IL)-1 antagonist anakinra in cases of GPP underscores the role of IL-1 in disease pathogenesis. We present a case of a middle-aged man who developed an abrupt and severe form of GPP with severe eosinophilia and cholestatic hepatitis. The patient received salvage treatment with a combination of glucocorticoids, hydroxyurea and imatinib, while administration of the IL-1 inhibitor anakinra resulted in remission of hepatitis and a significant skin improvement. However, due to persistent hypersensitivity skin reactions, anakinra was withdrawn and replaced with the anti-IL-1β antagonist canakinumab. As a result of canakinumab, the patient's skin completely cleared, while no systemic manifestations recurred. After 1 year of continuous canakinumab therapy, the patient remained virtually free of symptoms, while the drug was well tolerated.