Dr Koh Hong Yi was interviewed by Lian He Zao Bao (联合早报), which is the main Chinese newspaper in Singapore, on his opinion on Psoriasis, in particular Generalized Pustular Psoriasis (GPP). The article was published on 22^nd October 2024.

Psoriasis is a chronic, inflammatory skin condition that affects 1 – 2% of the world’s population. The most common type of psoriasis is plaque psoriasis, where patients develop thick, red and scaly patches on their scalp, body and limbs. The condition is distressing to patients because the patches of inflamed skin can be itchy or painful, and the scales fall all over the place. Some patients also develop nail psoriasis and psoriatic arthritis.

Generalized pustular psoriasis (GPP) is a rare and severe form of psoriasis.  Patients with GPP have recurrent and sudden episodes of bright red and inflamed skin that can cover large parts of the body. On top of these red patches are numerous pustules (small blisters that are filled with pus). The skin feels very warm and painful, and when the pustules break, they release pus that flow on the skin and stain clothes.

Patients with GPP can become very ill, feverish, tired and develop joint pains. They will often need to be admitted to the hospital for urgent treatment.

Because GPP is a rare disease, it can sometimes be missed by non-dermatologists or doctors who are not familiar with treating psoriasis or GPP. For example, the pustules and pus may be mistaken for bacterial infection and treated with antibiotics. A missed diagnosis can lead to delay in initiating the right treatment. Poorly or untreated GPP may lead to severe injuries or even death.

GPP’s rarity also means there was no standard treatment licensed specifically to treat it. Most treatments are used based on their efficacy in plaque psoriasis. The commonest treatments include biologics (such as adalimumab, infliximab, secukinumab, ixekizumab, etc) and conventional oral medicines like acitretin and cyclosporine.

The situation changed in 2022, when a medication called spesolimab was approved by the US Food and Drug Administration (FDA) to treat adult patients with GPP flares. Spesolimab is a biologic (targeted therapy) that specifically blocks interleukin-36 (IL-36), a chemical that is secreted by immune cells in the body and is thought to be critical in giving rise to GPP. This marks the first time that a medication was specifically licensed to treat GPP flares, based on clinical trials involving GPP patients. In phase 3 trials, spesolimab was able to control GPP flares significantly better than placebo. Some patients even noticed clearance of their skin within a few days.

In 2024, spesolimab was further approved to treat GPP flares in children aged 12 and above.

While these results are encouraging, we need to note that GPP is a chronic disease and patients require long term follow-up and treatment. There are now ongoing trials looking at whether any medications can be used regularly to prevent flares of GPP. As the medication is relatively new, we will also need to follow-up patients to monitor for any long-term side effects.

If you are suffering from Psoriasis or Generalized Pustular Psoriasis and need advice for medical care, please contact TSN Dermatology Skin Specialist Clinic for further discussion with our skin specialists .

Source URL: https://www.zaobao.com.sg/lifestyle/health/story20241022-5166730