Briefly Noted

Management of Patients with Pustular Psoriasis

Pustular psoriasis may be generalized or localized. Generalized pustular psoriasis (GPP) may be associated with severe, and at times life-threatening, disease, whereas localized pustular psoriasis (LPP) usually occurs on the palms or soles and is often disabling. No high-quality, evidence-based studies demonstrate effective treatment of GPP, but there is one placebo-controlled study utilizing cyclosporin for LPP.

These authors1 performed a thorough literature review and offer this guidance: For GPP, acitretin, cyclosporin, methotrexate, or infliximab should be the first-line therapy, with other anti-TNF agents, PUVA, and various topical agents as a second line. In pregnant women with GPP, avoid r…