title: Granulocyte and Monocyte Adsorption Apheresis for Generalized Pustular Psoriasis: Therapeutic Outcomes in Three Refractory Patients.
abstract: Generalized pustular psoriasis (GPP) is a type of neutrophilic dermatosis that is sometimes resistant to medications. In patients with neutrophilic skin diseases, granulocyte and monocyte adsorption apheresis (GMA) has been demonstrated to selectively and efficiently eliminate myeloid-lineage leukocytes from the peripheral blood. We evaluated the efficacy and safety of repeated GMA therapy in three refractory GPP patients. Three GPP patients refractory to previous therapies received weekly GMA with five sessions per course, which was repeated when the symptoms reappeared. The efficacy was assessed by the disease severity scores 2 weeks after each course of GMA. The GPP severity scores of all three patients were reduced in all courses (N = 9); they were reduced by more than 3 points in six courses and by 2 points in three courses. After the first GMA course, the GPP severity scores were reduced by more than 3 points in all three patients. On average, the GPP severity scores were reduced by 4.67 and 3.67 points after the first course and repeated courses, respectively. The severity of edema and pustules were particularly improved in all patients and no adverse effects were observed. GMA showed efficacy for the treatment of refractory GPP patients as a non-pharmacologic intervention without any associated adverse effects, and was particularly effective in the first course, but also effective in the subsequent courses.
authors.affiliation: Department of Dermatology, Gifu University Graduate School of Medicine, Gifu, Japan.
authors.forename: Tomomi
authors.initials: T
authors.lastname: Fujisawa
authors.affiliation: Department of Dermatology, Gifu University Graduate School of Medicine, Gifu, Japan.
authors.forename: Satoko
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: Department of Dermatology, Gifu University Graduate School of Medicine, Gifu, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Mizutani
authors.affiliation: Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Doi
authors.affiliation: Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.
authors.forename: Shozo
authors.initials: S
authors.lastname: Yoshida
authors.affiliation: Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Ogura
authors.affiliation: Department of Dermatology, Gifu University Graduate School of Medicine, Gifu, Japan.
authors.forename: Mariko
authors.initials: M
authors.lastname: Seishima
mesh_terms: D000328:Adult; D001781:Blood Component Removal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D016572:Cyclosporine / Q000627:therapeutic use*; D004351:Drug Resistance; D005260:Female; D006098:Granulocytes; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D009000:Monocytes; D010789:Phototherapy / Q000379:methods; D011565:Psoriasis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D008727:Methotrexate
keywords: Apheresis; Generalized pustular psoriasis; Granulocytapheresis; Granulocyte and monocyte adsorption apheresis