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The Goeckerman Regimen for the Treatment of Moderate to Severe Psoriasis
Published on: July 11, 2013
Clinical Features, Treatment Effectiveness and Long-Term Outcomes in Children with Moderate-to-Severe Generalized
Zhiqiang Cao1, Bin Peng1, Zonghao Li2
1Department of Dermatology, Northwest Hospital, The Second Hospital Affiliated of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, People's Republic of China.
Insights
Biologics offer faster, safer treatment for pediatric generalized pustular psoriasis (GPP). This rare skin disorder showed reduced hospitalization and recurrence rates with biologics compared to traditional drugs.
Area of Science:
- Dermatology
- Immunology
- Pediatrics
Background:
- Generalized pustular psoriasis (GPP) is a rare, severe inflammatory skin condition with systemic effects.
- Pediatric GPP presents distinct clinical features requiring specialized treatment, yet real-world data are scarce.
- Understanding pediatric GPP is crucial for developing effective management strategies.
Purpose of the Study:
- To characterize clinical profiles of pediatric moderate-to-severe GPP.
- To assess the efficacy of different treatments for pediatric GPP.
- To evaluate the impact of treatments on GPP recurrence in children.
Main Methods:
- Retrospective observational study of pediatric moderate-to-severe GPP inpatients (March 2017-February 2024).
- Data collection included clinical characteristics, treatment regimens, and recurrence via electronic medical records and follow-up.
- Serum proteomic analysis was performed to investigate underlying mechanisms.
Main Results:
- 61 pediatric patients (mean age 10.6 years) with GPP were analyzed; 93.4% had concomitant symptoms.
- Biologics significantly reduced hospitalization time (6.0 vs 8.0 days) and pustule clearance time (3.0 vs 7.0 days) versus traditional drugs.
- The biologics group showed lower annual flares (0 vs 0.3) and recurrence rates (21.1% vs 60.0%) compared to traditional drugs.
Conclusions:
- Biologics demonstrate superior effectiveness and safety over traditional systemic drugs for moderate-to-severe pediatric GPP.
- Biologic therapies significantly shorten hospitalization and pustule clearance times.
- Biologics effectively decrease disease recurrence in pediatric GPP patients.
Background:
Generalized pustular psoriasis (GPP) is a rare inflammatory skin disorder, frequently accompanied by systemic inflammatory manifestations. Pediatric GPP presents unique clinical features and requires tailored treatment approaches. However, real-world data on pediatric moderate-to-severe GPP remain limited.
Objective:
To describe the clinical profiles of pediatric moderate-to-severe GPP, evaluate the effectiveness of various treatments, and their impact on disease recurrence.
Methods:
This retrospective observational study enrolled pediatric moderate-to-severe GPP inpatients in our department from March 2017 to February 2024. Clinical characteristics, treatment regimens, and recurrence were collected and analyzed using electronic medical records and follow-up data.
Results:
61 pediatric patients were included, with a male-to-female ratio of 1.54: 1, an average age of 10.6±3.2 years. Concomitant symptoms were present in 93.4% of patients, including pruritus, fever, and skin pain. Common comorbidities included hypoproteinemia, anemia, and hyperlipidemia. Over 80% of patients exhibited elevated inflammatory markers, including IL-6, TNF-α. GPP with psoriasis vulgaris (PV) and without PV had similar clinical presentations. Regarding treatment outcomes, compared with traditional drugs, biologics significantly reduced both hospitalization time (6.0 days vs 8.0 days, P=0.002) and pustule clearance time (3.0 days vs 7.0 days, P=0.013), with a lower incidence of adverse events. Post-discharge follow-up data on annual flare indicated the biologics group was associated with fewer annual flares (0 vs 0.3 per person-year, P=0.052) and lower recurrence rate (21.1% vs 60.0%, P=0.034), compared with the traditional drugs group. Furthermore, serum proteomic analysis revealed significantly elevated IL-17 level and activation of the IL-17 signaling pathway in pediatric GPP compared with healthy controls, elucidating the mechanism underlying the high effectiveness of biologic-targeted therapies.
Conclusion:
For moderate-to-severe pediatric GPP, biologics exhibit faster effectiveness and better safety than traditional systemic drugs. Specifically, biologics can significantly reduce hospitalization time and pustule clearance time, and decrease disease recurrence.
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