Spesolimab for acute-flare generalized pustular psoriasis with severe erythema and plaques: A case report

Psoriasis is a prevalent, chronic papulosquamous skin disease, with generalized pustular psoriasis (GPP) representing a severe variant. Dysregulation of the IL-36 signaling pathway plays a crucial role in GPP, making biologics targeting this pathway the current therapeutic focus.

An elderly male patient presented with recurrent generalized erythematous, scaly patches and pustules. His medical history included GPP, psoriatic arthritis, rheumatoid arthritis, and type 2 diabetes mellitus. Previous treatments included methotrexate, glimepiride, metformin and voglibose, and adalimumab.

GPP was diagnosed based on clinical presentation, laboratory findings, and histopathological examination.

Due to inadequate response to previous treatments, spesolimab (900 mg) was administered via intravenous infusion.

Skin lesions subsided rapidly within 1 week after the initial dose. At the 6-month follow-up, the patient remained in complete clinical remission without adverse events.

This case demonstrates that spesolimab is highly effective not only for pustules in GPP but also promotes excellent regression of erythema and plaques.