Efficacy of granulocyte and monocyte adsorption apheresis for pustular psoriasis

Granulocyte and monocyte adsorption apheresis (GCAP) has recently shown remarkable effects on ulcerative colitis, which is characterized by inflammation and neutrophil infiltration. Pustular psoriasis often shows histological findings of neutrophilic pustules in the epidermis, and in Japan is usually treated with etretinate or immunosuppressive agents. However, there are some resistant cases to these therapies. We performed GCAP on one patient with generalized pustular psoriasis (patient 1) and on one patient with acrodermatitis continua, a subtype of pustular psoriasis limited to acral lesions (patient 2). Patient 1, a 44-year-old woman suffering from alcoholic liver cirrhosis and osteoporosis as a result of the liver cirrhosis, received two GCAP sessions because cyclosporine was ineffective. Patient 2, a 66-year-old man with hypertension who had suffered from a brain infarction 4 years before, had five GCAP sessions because etretinate was ineffective. GCAP remarkably improved the skin lesions in both patients. No adverse effects were observed either during or after treatment. From these findings, GCAP could be an effective therapy for refractory cases of pustular psoriasis.