title: Biologic therapy in erythrodermic and pustular psoriasis.
abstract: BACKGROUND
  The efficacy of biologic therapy in treating plaque-type psoriasis is well documented. However, there is less data for use in other psoriasis subtypes, such as erythrodermic and generalized pustular psoriasis.
  
  
  OBJECTIVE
  We sought to review the safety and efficacy of biologic medications in the treatment of these severe subtypes of psoriasis and to identify strategies to help clinicians optimally manage these patients.
  
  
  METHODS
  We searched Pubmed for English language literature that assessed the use of biologic medication to treat erythrodermic or generalized pustular psoriasis.
  
  
  RESULTS
  The primary literature included cases reports, cases series, and open-label, uncontrolled trials. There were no head-to-head studies or other controlled trials. In both erythrodermic and generalized pustular psoriasis, infliximab was used to treat over half of the reported cases. Other biologic medications that were successfully used included etanercept, ustekinumab, adalimumab, and anakinra. Most cases reported improvement with biologic therapy. Serious adverse events were reported in 10-12% of the patients.
  
  
  CONCLUSIONS
  Although the evidence is limited, biologic therapy appears to be effective in treating erythrodermic and generalized pustular psoriasis. In order to assess the comparative efficacy and safety of the biologic medications, larger controlled studies are needed.
authors.forename: Ethan C
authors.initials: EC
authors.lastname: Levin
authors.forename: Maya
authors.initials: M
authors.lastname: Debbaneh
authors.forename: John
authors.initials: J
authors.lastname: Koo
authors.forename: Wilson
authors.initials: W
authors.lastname: Liao
mesh_terms: D001691:Biological Therapy / Q000009:adverse effects / Q000379:methods*; D003879:Dermatologic Agents / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects / Q000627:therapeutic use*; D011565:Psoriasis / Q000188:drug therapy* / Q000473:pathology; D012720:Severity of Illness Index
chemical_list: D003879:Dermatologic Agents; D007155:Immunologic Factors