2026-07-10 | Upadacitinib Successfully Treated Dupilumab-Associated Generalized Pustular Psoriasis in a Pediatric Patient with Atopic Dermatitis: A Case Report.
Atopic dermatitis (AD) and psoriasis are both T-cell-mediated inflammatory skin diseases. While dupilumab effectively treats moderate-to-severe AD, paradoxical psoriasiform eruptions, including rare cases of generalized pustular psoriasis (GPP), have been reported. These reactions often show poor response to conventional therapies, presenting significant therapeutic challenges. We present a case of a 6-year-old child with AD who developed GPP following dupilumab therapy and was successfully treated with upadacitinib. A 6-year-old girl with a 5-year history of AD was initiated on dupilumab therapy after an inadequate response to antihistamine treatment. Although initial symptoms improved, the patient rapidly developed GPP-like skin lesions throughout the body on day 11. Despite treatment with high-dose corticosteroids and cyclosporine, the patient experienced recurrent generalized pustules and developed erythrodermic psoriasis-like manifestations. Subsequently, upadacitinib was added at a dose of 15 mg every other day, following which the skin lesions gradually improved and completely resolved within 1 month. During the subsequent 6-month follow-up period on continued medication, no recurrence of skin lesions or adverse events was reported. This case provides a reference for the efficacy and safety of upadacitinib in a pediatric patient with AD who developed secondary GPP following dupilumab therapy. Upadacitinib may represent a valuable therapeutic option for dupilumab-associated paradoxical psoriasis (including GPP) in AD patients. Prospective studies are needed to establish its long-term safety and efficacy in this patient population.
Open article ↗
2026-07-03 | Management of Generalized Pustular Psoriasis Flare with Intravenous Spesolimab Followed by Long-Term Treatment with Subcutaneous Spesolimab: A Case Report.
This case report describes the clinical course and treatment of generalized pustular psoriasis (GPP) flare with intravenous (i.v.) spesolimab, an anti-IL-36R antibody, and subsequent long-term disease management with subcutaneous (s.c.) spesolimab. A 72-year-old female patient had an ongoing GPP flare for 1 month before presenting to the hospital for flare and related multiorgan failure. She was successfully treated with 2 infusions of 900 mg i.v. spesolimab 1 week apart. She then initiated therapy with 300 mg s.c. spesolimab every 4 weeks for the long-term treatment of GPP. Rapid and significant improvement of skin and systemic symptoms was observed within 1 week of receiving i.v. spesolimab. However, the severity of the patient's prolonged flare deteriorated her functional status, and she required rehabilitation post-discharge. At follow-ups, s.c. spesolimab demonstrated favorable efficacy and tolerability, with no flare recurrence. Mild superficial desquamation reappeared in the days before consecutive spesolimab doses, with complete skin recovery achieved post-dose. This case underscores the serious complications arising from untreated flare and the need for long-term management of chronic GPP. The patient's ongoing post-flare symptoms highlight the chronicity of GPP, and continuous targeted treatment with spesolimab improved both her symptoms and quality of life.
Open article ↗
2026-06-29 | Case Report: Successful treatment of refractory generalized pustular psoriasis with xeligekimab: a report of two cases.
Generalized pustular psoriasis (GPP) is a severe, relapsing skin disorder characterized by widespread erythema and sterile pustules. Classical systemic therapies often yield suboptimal results. Xeligekimab is a novel, fully human anti-interleukin-17A (anti-IL-17A) monoclonal antibody recently approved in China for plaque psoriasis. Its efficacy in GPP has not been previously reported. This report presents two cases of refractory GPP successfully treated with xeligekimab. Both patients- a 25-year-old male and a 70-year-old male had long-standing GPP that was unresponsive to conventional systemic therapies including acitretin and methotrexate. After receiving a single 200 mg dose of xeligekimab, both patients exhibited rapid and significant clinical improvement within 3 to 4 days. Remarkably, one patient remained in remission at the 3-month follow-up after only one injection. This is the first report to suggest that xeligekimab is a potent and promising therapeutic option for inducing rapid and sustained remission in patients with GPP.
Open article ↗
