Efficacy of adalimumab in pediatric generalized pustular psoriasis: case series and literature review

Abstract

Background Generalized pustular psoriasis (GPP) is a rare, severe, and sometimes fatal form of childhood psoriasis. The first line therapies include acitretin, cyclosporin A, and methotrexate which take effect slowly and have varying long-term side effects for children. Recently, the anti-tumor necrosis factor-alpha (TNF-α), adalimumab has shown efficacy in adult patients with pustular psoriasis; however, there is lack of evidence of its usage in the pediatric population. Methods Data on efficacy of adalimumab in treating pediatric GPP along with a literature review are presented. Results A total of seven patients had marked clearance and reduction in PGA and systemic/laboratory score within the first week of first injection and achieved almost complete clearance of skin lesions by 1-month follow up. In literature, adalimumab treating pustular psoriasis in pediatric has been described in six children who failed in prior treatment. All six patients showed a satisfactory therapeutic effect. Conclusions Subcutaneous injection of adalimumab every other week in the treatment of children with GPP has significant clinical efficacy with rapid clearance of skin lesions, providing a novel alternative for children with pustular psoriasis who responded poorly to traditional treatment or are not suitable for traditional treatment.