China
Africa
Explore chapters and articles related to this topic
Psoriatic erythroderma
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
Psoriasis accounts for approximately 25% of all erythrodermas and is the most common cause of erythroderma in adults in India and second globally. Psoriatic erythroderma is one of the most severe forms of psoriasis, which causes significant morbidity and is also potentially life threatening. It occurs in 1%–2.25% of all of the psoriatic cases [1]. Erythroderma can occur because of progressive worsening of plaque psoriasis or can be aggravated due to certain precipitating factors. Rarely, it could be the initial manifestation of psoriasis [2,3].
Biological treatment for erythrodermic psoriasis
Published in Expert Opinion on Biological Therapy, 2022
Infliximab is a chimeric monoclonal antibody targeting both soluble and membrane-bound TNF-α. Due to rapidity of onset of action, it has been recommended as a first-line management option in patients with acute psoriatic erythroderma [27]. A prospective post-marketing surveillance study reported results from 45 EP patients followed up for a period of 6 months [28]. A response rate of 84.4% was observed, with 33 patients rated as ‘improved’ and 5 patients as ‘resolved.’ Adverse effects were reported in nine patients (20%), including five infections (11.1%). Successful combination of infliximab with methotrexate and acitretin has been documented in EP [29,30]. Literature suggests that infliximab loses efficacy over time, likely due to the development of anti-drug antibodies [23,26,31]. A significant rise in biologic autoimmunity has also been documented. In 28 patients with severe recalcitrant psoriasis, incidence of positive antinuclear antibody (ANA) results rose from 12% at baseline to 72% at week 22 [32]. Development of ANA after infliximab infusion has been suggested as a marker of forthcoming therapeutic failure [33]. Moderate-to-high ANA titers have also been associated with paradoxical psoriasis after infliximab infusion [34].
A case of severe psoriatic erythroderma with COVID-19
Published in Journal of Dermatological Treatment, 2022
Fariba Ghalamkarpour, Mohammad Reza Pourani, Fahimeh Abdollahimajd, Omid Zargari
Management of severe dermatologic disorders in patients who require systemic immunosuppressive treatment has become a major concern in COVID-19 pandemic era (9,10). There are still some controversies about immunosuppressive treatments in this period (10,11). Therefore, authorities believe that management of severe cases should be individualized (9–11). In this patient, considering positive PCR test and blood culture , at first we tried to control the disease with acitretin. The response was good with appearance of normal skin islands on his body but it was slow; with progression of arthritis, we decided to start cyclosporine and a low dose of prednisolone. A remarkable improvement was noticed in his condition soon after the administration of cyclosporine and low dose prednisolone. There were few reports of psoriatic erythroderma in COVID19 era. A report from Italy explained a patient with psoriatic erythroderma with concomitant oligodendroglioma, which highly limited treatment options. He responded well to apremilast 30 mg twice a day and prednisolone (12). Another psoriatic erythroderma patient with COVID-19 also reported from Italy recovered completely with anti-IL23 (guselkumab) (13). An Iranian patient with psoriasis discontinued MTX plus cyclosporine because of COVID-19 infection, but secondary to complete recovery from SARS-CoV-2 he returned with erythroderma. Administration of cyclosporine led to his gradual improvement (14).
Targeting IL-17A for the treatment of pustular psoriasis: a comprehensive review
Published in Expert Opinion on Biological Therapy, 2022
Elia Rosi, Maria Thais Fastame, Antonella Di Cesare, Francesca Prignano
An open-label, multicenter, long-term (52 weeks) phase 3 study in Japanese patients was conducted to evaluate BRO efficacy and safety for GPP and psoriatic erythroderma. A total of 12 GPP patients (3 males) were enrolled. Among GPP patients, previous treatments included: adalimumab (n = 2), infliximab (n = 6), and ustekinumab (n = 2). Nine out of 12 (75.0%) and 11/12 (91.7%) of GGP patients achieved a CGI categorized as ‘improved’ or ‘remission’ at Week 2 and at Week 52, respectively. Eleven out of 12 GPP patients reported AEs and the most common AE was ‘nasopharyngitis’ in 4/12 (33.3%) (Table 3) [62].