Treatment for pustular psoriasis, a rare form of psoriasis with a limited research scope, should be dictated by the extent of involvement and disease severity, according to a recent study recommendation.
Researchers representing a task force of the National Psoriasis Foundation Medical Board conducted a literature review to assess and present treatment recommendations for patients with pustular psoriasis. The overall quality of literature on treatment modalities was found to be “weak” and limited in evidence-based reports and controlled trials, the researchers said. They said treatment should be classified for those with either generalized pustular psoriasis (GPP), including children and pregnant women, or localized forms, known as palmoplantar pustular psoriasis (PPPP). In children, pregnant women, and in localized forms, first-line modalities may be altered to factor in concerns about teratogenicity.
First-line treatment for GPP in adults included acitretin, cyclosporine, methotrexate or infliximab. Although data is limited, infliximab is considered first-line therapy by some clinicians because of its faster onset. Second-line therapy listed adalimumab, etanercept and the combination psoralen/ultraviolet A (PUVA) with either acitretin or cyclosporine.
For children with GPP, the researchers wrote that acitretin, a combination of acitretin/oral prednisone, methotrexate or cyclosporine were first-line therapy, and they said some experts would suggest etanercept. They noted that acitretin is not FDA approved for use in children. Second-line treatment for children included adalimumab, infliximab and ultraviolet B (UVB) phototherapy.
Limited data are available for treating pregnant women with GPP. Researchers listed first-line therapy as cyclosporine, oral corticosteroids and topical agents. Narrowband UVB or oral PUVA were the second-line treatments in this setting.
For PPPP, first-line therapies included topical corticosteroids, calcipotriene and combination products. Second-line treatments were photodynamic therapy and topical tacrolimus.
“Treatment of patients with pustular psoriasis depends on the severity of presentation and a patient’s underlying risk factors,” the researchers concluded. “The data are extremely limited in this type of psoriasis, and we encourage further exploration into the optimization of these medications in this setting.”
Disclosure: See the study for a full list of relevant disclosures.