Effectiveness and Safety of Spesolimab in Adolescents and Adults with Generalized Pustular Psoriasis

Generalized pustular psoriasis (GPP) is a rare, severe, and potentially life-threatening inflammatory skin disease characterized by widespread erythema, pustules and systemic involvement. Evidence-based treatment guidelines for adolescents with GPP remain limited. Spesolimab, a parenteral humanized monoclonal antibody targeting the interleukin-36 receptor, has emerged as a novel therapeutic option; however, data on its use in adolescents are scarce. Here, we aimed to evaluate the effectiveness of spesolimab in treating GPP episodes in adolescents and compared their outcomes with those in adults.

We analyzed the management of GPP episodes with spesolimab in two adolescent and four adult patients in our unit and conducted a literature review involving 25 patients. Clinical outcomes included response to treatment, pustule resolution, and infection management. Spesolimab achieved rapid and sustained symptom control in all patients, including those with coexisting plaque psoriasis.

Twenty-two patients (71.0%) experienced complete pustule resolution within 1 week, and all 31 patients achieved complete pustule resolution by week 4. Treatment responses in adolescents were comparable to those in adults. Infections were identified as key exacerbating factors and managed accordingly.

IL-36R inhibitors, such as spesolimab, are potentially effective and safe treatment for both adolescent and adult patients with GPP. Future studies should explore the long-term efficacy of spesolimab and its application strategy of sustained disease control.