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A dramatic response to a single dose of infliximab as rescue therapy in acute generalized pustular psoriasis of von Zumbusch associated with a neutrophilic cholangitis
Author(s) -
Chandran Nisha Suyien,
Chong WeiSheng
Publication year - 2010
Publication title -
australasian journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.67
H-Index - 53
eISSN - 1440-0960
pISSN - 0004-8380
DOI - 10.1111/j.1440-0960.2009.00588.x
Subject(s) - medicine , infliximab , generalized pustular psoriasis , psoriasis , rescue therapy , pustular psoriasis , dermatology , maintenance therapy , tumor necrosis factor alpha , chemotherapy
Generalized pustular psoriasis of von Zumbusch is an unstable, inflammatory form of psoriasis, with the hallmark of neutrophil infiltration in cutaneous as well as extracutaneous lesions. It is often recalcitrant, making treatment difficult. Tumour necrosis factor‐α antagonists including infliximab have been used with success in treating recalcitrant cases. We report a case of a 48‐year‐old Chinese female patient with a long‐standing history of poorly controlled generalized pustular psoriasis which was resistant to multiple therapies. During a severe flare, a single dose of infliximab resulted in rapid clearing of cutaneous lesions, together with resolution of liver function abnormalities that are likely secondary to neutrophilic cholangitis. Subsequent maintenance therapy with acitretin allowed remission of pustular disease for 7 months. This demonstrates the efficacy of single‐dose infliximab for both cutaneous lesions and systemic hepatic involvement in generalized pustular psoriasis.