Granulocyte and monocyte apheresis can control juvenile generalized pustular psoriasis with mutation of IL 36 RN

Summary Patients with deficiency of interleukin‐36 receptor antagonist ( DITRA ), due to mutation of IL 36 RN , exhibit psoriatic phenotypes, typically generalized pustular psoriasis ( GPP ). We report a paediatric patient with DITRA , whose cutaneous lesions varied from psoriasis vulgaris in infancy to annular pustular psoriasis with acute exacerbation to GPP at 13 years of age. Conventional systemic treatments for GPP , which include oral retinoids, ciclosporin and methotrexate, are controversial in paediatric cases, because of their adverse effects and uncertain long‐term consequences. Granulocyte monocyte apheresis, a process associated with few adverse events, promptly controlled the GPP of our paediatric patient, and has potential as a suitable alternative treatment for paediatric patients with DITRA .