title: Therapeutic depletion of myeloid lineage leukocytes in patients with generalized pustular psoriasis indicates a major role for neutrophils in the immunopathogenesis of psoriasis.
abstract: BACKGROUND
  Generalized pustular psoriasis (GPP) is a chronic autoimmune disease characterized by fever, erythema, and neutrophilic pustules over large areas of the skin. GPP does not respond well to pharmacologic intervention.
  
  
  OBJECTIVE
  We sought to assess efficacy of selectively depleting the myeloid lineage leukocytes in patients with GPP.
  
  
  METHODS
  Fifteen patients with persistent moderate to severe GPP despite conventional therapy were included. Eligible patients had more than 10% of their skin area covered by pustules. Treatment with oral etretinate, cyclosporine, methotrexate, prednisolone, and topical prednisolone/vitamin D3 was continued if had been initiated well in advance of study entry. Five sessions of adsorptive granulocyte and monocyte apheresis (GMA) with the Adacolumn (JIMRO Co Ltd, Takasaki, Japan) were administered (1 session/wk over 5 weeks) to selectively deplete Fcγ receptor and complement receptor bearing leukocytes. Efficacy was assessed by measuring the skin areas covered by pustules at baseline and 2 weeks after the last GMA session.
  
  
  RESULTS
  One patient did not complete the first GMA session. Based on the GPP severity scores relative to entry, the overall scores improved (n = 14, P = .0027), and the area of erythroderma (P = .0042), pustules (P = .0031), and edema (P = .0014) decreased. Likewise, Dermatology Life Quality Index improved (P = .0016), reflecting better daily function and quality of life. Twelve patients were judged as responders (85.7%), and 10 patients maintained the clinical response for 10 weeks after the last GMA session without any change in medication.
  
  
  CONCLUSIONS
  This study was unblinded and without a placebo arm.
  
  
  CONCLUSIONS
  GMA in this clinical setting was safe and effective, suggested a major role for granulocytes/monocytes in the immunopathogenesis of GPP.
authors: Department of Dermatology and Allergology, Juntendo University Graduate School of Medicine, Tokyo, Japan. Electronic address: ikeda@juntendo.ac.jp.
authors: Shigaku
authors: S
authors: Ikeda
authors: Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan.
authors: Hidetoshi
authors: H
authors: Takahashi
authors: Department of Dermatology, Juntendo University Urayasu Hospital, Chiba, Japan.
authors: Yasushi
authors: Y
authors: Suga
authors: Department of Dermatology, St Luke's International Hospital, Tokyo, Japan.
authors: Hikaru
authors: H
authors: Eto
authors: Department of Dermatology, Tokyo Teishin Hospital, Tokyo, Japan.
authors: Takafumi
authors: T
authors: Etoh
authors: Department of Dermatology and Allergology, Juntendo University Graduate School of Medicine, Tokyo, Japan.
authors: Keiko
authors: K
authors: Okuma
authors: Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors: Kazuo
authors: K
authors: Takahashi
authors: Department of Dermatology, Yokohama City University Medical Center, Yokohama, Japan.
authors: Takeshi
authors: T
authors: Kanbara
authors: Department of Dermatology, Gifu University Graduate School of Medicine, Gifu, Japan.
authors: Mariko
authors: M
authors: Seishima
authors: Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors: Akimichi
authors: A
authors: Morita
authors: Department of Dermatology, Hyogo College of Medicine, Hyogo, Japan.
authors: Yasutomo
authors: Y
authors: Imai
authors: Department of Dermatology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
authors: Takuro
authors: T
authors: Kanekura
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D047589:Leukocyte Reduction Procedures; D007962:Leukocytes / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000276:immunology* / Q000473:pathology / Q000628:therapy*