Psoriasis is a chronic inflammatory disease predominantly affecting the skin. Acute generalized pustular psoriasis (GPP) is one of the rarest and most severe types of psoriasis. GPP manifests as spontaneously occurring specific skin lesions and is accompanied by a worsening of the general condition (fever, chills, malaise, nausea, severe pain, joint pain). Among the factors provoking pustular psoriasis are abrupt withdrawal of systemic steroid drugs, pregnancy, hypocalcemia, upper respiratory tract infections, and mental disorders. The main pathophysiological mechanism of the occurrence and progression of GPP is the migration of polymorphonuclear leukocytes from the vascular wall into the tissues and the activation of interleukins and nonspecific cytokines. Acitretin, cyclosporine, and methotrexate are used as first-line therapy. In addition, retinoids are also used in the basic therapy of various types of psoriasis. Second-line therapy includes adalimumab, etanercept, PUVA therapy, topical corticosteroids, and topical calcipotriol. The UK National Institute for Health and Clinical Excellence (NICE) has issued guidelines on non-biological therapies.
A clinical case of Zumbusch-type GPP in a 25-year-old patient with a history of the disease since 3 years old is described.
MATERIAL AND METHODS
Treatment included cyclosporine A in the first phase and the combination of retinoids with total PUVA therapy in the second phase.
This treatment method made it possible to achieve 100% regression of the rash and ensure the absence of relapses without expensive biologicals.
The results suggest that effective treatment of acute GPP (Zumbusch type) is possible without biological therapy.