Call Us : +41 22 738 18 48

Generalized Pustular Psoriasis: an Inexpensive Treatment ?

Take Home Message: Dapsone can be used in the Management of Generalized Pustular Psoriasis (Von Zumbusch) (Case Report from Indonesia)

 

Comments:

-Von Zumbusch generalized pustular psoriasis is a systemic inflammatory pustular psoriasis reaction (Localized pustular psoriasis includes Acrodermatitis of Hallopeau).

-The pustules are therefore “sterile”.

-First line management consists of retinoids (acitretin…)

-Dapsone is classified as an essential drug by the World Health Organization (WHO). It has been around for a very long time, and is therefore available as an inexpensive generic drug.

-In this indication it acts as an anti-inflammatory drug as pustular psoriasis is not infectious in origin (dapsone was first used as an antibiotic to treat Hansen’s disease (leprosy))

-Dapsone use needs to be monitored: there is a reddish discoloration of the skin, possible hemolysis (red blood cells) and liver inflammation.

-Drug hypersensitivity can develop in 1.4% (0.5-3.6%) of cases and can lead to death in 10% of cases. The population of Chinese descent seems to be more at risk. (Source: click HERE)

-To read guidelines on the management of Pustular Psoriasis, click HERE.

 

Abstract:

-Introduction: Generalized Pustulous Psoriasis Von Zumbuch (GPP) is characterized by acute febrile pustular psoriasis. Provoking agents include infections and withdrawal oral corticosteroids. Management include methotrexate, etretinate and cyclosporin. In a case of patient with liver disfunction can be treated with Dapsone as an alternative therapy.

-Case Report: Female, 37 years old with redness patches on almost of her body, some small blister appeared with creamy-whitish fluid on her arms, stomach, chest, back and leg and accompanied by a febrile peak. There is a history of similar disease before. Had corticosteroid injections from midwife. General examination: looks ill, temperature 38,5°C, blood pressure 90/50 mmHg. Dermatologic examination found erythematous plaque, ill defined, irregular shape with small non-follicular pustules. Lake of pus (+). Blood examination shows leucocytosis, neutrophilia, transaminitis, increase CRP quantitative. Gram staining of pus: no bacteria. Histopathological pictures showed subcorneal or intra epidermal spongiform pustules, parakeratosis, hyperkeratosis, giant abscess munro and spongiform pustules of Kogoj. The treatment was given Dapsone 1 x 50 mg/day for 1 week, due to transaminitis and completely resolved with some desquamation.

-Discussion: Diagnosis GPP in this case based on anamnesis, clinical manifestation and histopathological findings. In this case, cause of GPP was due to history of past illness and elicited by physical stress. The treatment is Dapsone 1×50 mg/day for 1 week. The finding of present case and review of relevant literature support the concept of the role of Dapsone in the management of GPP.

 

Reference: Regional Congress of Dermatology (RCD) 2016 – Singapore. RCD16-0371 Psoriasis GENERALIZED PUSTULAR PSORIASIS TREATED WITH DAPSONE S. Anindita1, A. rofiq2 1, Malang, Indonesia 2Brawijaya University, Dermatovenereology, Malang, Indonesia