Combination of Low-Dose Methotrexate with Cyclosporine as Management for Generalized Pustular Psoriasis
Keywords:
Cyclosporine, Combination Therapy, Methotrexate, Generalized Pustular PsoriasisAbstract
Generalized pustular psoriasis (GPP) is a rare, life-threatening dermatosis marked by sterile pustules, systemic inflammation, and multi-organ involvement. We report a 26-year-old obese female with sudden-onset erythematous plaques, pustules, and erosions covering >90% of her body, accompanied by fever and arthralgia. Histopathology revealed Kogoj pustules and neutrophilic infiltrates, confirming GPP. Initial methylprednisolone therapy failed to prevent recurrence. Combination therapy with low-dose methotrexate (7.5–15 mg/week) and cyclosporine was initiated, alongside topical corticosteroids and wet dressings. Notable clinical improvement was seen within 30 days without any negative effects. This case highlights the synergistic effectiveness of methotrexate-cyclosporine treatment in refractory GPP cases, considering hyperproliferation is managed with methotrexate and T-cell activation is managed with cyclosporine. The response was quick, along with a good safety profile suggesting the treatment may be used instead of biologics where resources are limited. More research needs to be done to develop combination therapy protocols for GPP.References
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