Generalized pustular psoriasis (GPP) associated with pregnancy may be successfully treated with secukinumab without any adverse events, according to a letter to the editor published in the Indian Journal of Dermatology, Venereology and Leprology.
In the letter, the researchers described 2 cases of maternal GPP. The first patient was a 26-year-old woman diagnosed with GPP 20 years earlier. In the past, treatment with steroids, azathioprine, cyclosporine, and acitretin would yield only a partial therapeutic response.
She presented with a GPP flare-up at 20 weeks of gestation. Her physical exam revealed a body temperature of 39 °C and brightly erythematous plaques with scattered pustules on the waist, abdomen, back, elbows, and lower limbs. “Routine laboratory examinations and serological tests for hepatitis B and interferon-gamma release assays were negative,” the authors wrote.
The patient received a secukinumab 300 mg subcutaneous injection on day 1 as well as 6 subcutaneous injections of 150 mg secukinumab on days 8, 15, 22, 29, and 60. Her treatment also included “rehydration, nutritional support, maintenance of electrolyte balance, antibiotic treatment with azithromycin, and topical emollients.”
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Shortly thereafter, the pustules and erythema diminished and the patient delivered a healthy baby with a normal birth weight and a normal Apgar score at the 37th week of gestation.
The second patient was a 27-year-old woman admitted to the hospital at 24 weeks of gestation due to a flare of chronic plaque psoriasis diagnosed 10 years ago. Before she got pregnant, she had already received secukinumab injections for 2 years.
Her physical exam showed multiple erythematous plaques on the trunk and limbs, with numerous tiny pustules, some of which coalesced into lakes of pus. Her laboratory exams including blood cell counts, liver and renal function, hepatitis B, and tuberculosis screening were all normal.
The patient was administered subcutaneous injections of secukinumab 150 mg at weeks 0, 1, 2, and 4. She responded well to treatment and subsequently delivered a full-term baby with a birth weight of 3700 g. At 1 year follow-up, there was no active disease and the patient had only post-inflammatory hyperpigmentation.
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“In contrast to glucocorticoids and cyclosporine, secukinumab has little effect on blood pressure and blood glucose in pregnancy,” Zhang and colleagues wrote. “Data also suggests that the spontaneous abortion rate related to its use was similar to that of the general population. No safety signals were identified regarding spontaneous abortions or congenital malformations.”
GPP is marked by generalized aseptic pustules on a background of erythema as well as fever, leukocytosis, and increased C-reactive protein, usually occurring during the third trimester. Although in rare cases it can progress into sepsis, treatment options remain limited due to possible fetal toxicity.
This article originally appeared on Rare Disease Advisor
Zhang J, Xia P, Wan L, Chen L, Zhou X, Chen J. Generalized pustular psoriasis of pregnancy successfully treated with secukinumab. Indian J Dermatol Venereol Leprol. Published online June 21, 2023. doi:10.25259/IJDVL_1060_2022