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CASE 1 Presentation: 61-Year-Old Female With GPP


Expert dermatologists review a case of a 61-year-old female patient with GPP with no personal or family history of the condition.

Raj Chovatiya, MD, PhD: So, with that being said, I’d love to kind of transition and talk a little bit about some cases. I know that you’ve had an interesting case recently, I’ve had as well, where both of us have a chance to actually use these medications, spesolimab, as Boni mentioned, which is a biologic therapy that blocks that excess IL-36 that’s really driving this neutrophilic inflammation. … I know that I would love to get her thoughts a bit on sort of our case and I’m sure the same as well. So, I’d say let’s get into it. So, we can start things off with a patient that I saw somewhat recently and this was a 61-year-old [woman]. And her history was interesting. She that she noted once upon a time, maybe several years ago that she had a rash on her feet that started off as a few small bumps that really wouldn’t heal. And then she noticed the big bumps started to spread up her leg, her arms, her hands and other areas of the body. She said that they kind of last for a few days. The bumps would sort of burst and it left the skin somewhat raw and scaly. I never biopsied her, but she had said that she had had a biopsy in a different office setting before she had moved from a different state, and the results had shown pustular psoriasis. And the biggest dilemma that she had faced was that, the physicians she had seen were debating whether this was palmoplantar pustulosis versus generalized pustular psoriasis [GPP]. And no point where she sort of really toxic in the hospital in the emergency department. She could have involved in kind of the hand-and-foot area. And she said over about 2 years, her disease actually was, several weeks of flaring, followed by quiescence. And she had several weeks of flaring with sort of pustules popping up and quiescent. And so, her medical history was sort of not super remarkable. She had migraines, hyperlipidemia, hypothyroidism, and the medications that go along with that. No family history of psoriasis, or allergies as well. But let me tell you about some of the treatment she used here, Boni. So, she tried an ultrapotent topical corticosteroid previously, which didn’t really help that much. She had done methotrexate, which she said didn’t agree with her and it didn’t really sort of help all that much either. She tried apremilast, PDE4, an oral medication, which she said had a little mild improvement, but she just continued due to insurance issues. When she restarted, it wasn’t really helping. And then she tried to ixekizumab, a biologic that blocks IL-17 which she just didn’t tolerate well. And interestingly, she developed a drug-induced lupus based on lab workup for use of ixekizumab. And so she was forced to discontinue there too. And so when she came to me, she was on acitretin which was not really helping her and you’re giving her a lot of GI [gastrointestinal]-related adverse events. And so, kind of parsing through all of that, we made the decision to go forward with treatment with spesolimab just based on sort of the symptoms, signs and pictures that she had showed us, sounding like GPP. But when you take a look at the images, you can actually see rapid clearance and improvement of her skin from the areas of involvement literally within the first week of treatment. She had one additional infusion of medication about 4 weeks later and she’s been free and clear since and has not had any sort of pustular type of outbreaks and has been really, really happy with the results.

Transcript edited for clarity.

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