CASE REPORT article
Front. Med.
Sec. Dermatology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1668675
This article is part of the Research TopicExploring Innovative Therapies for Rare Inflammatory Skin DiseasesView all 12 articles
Combination Therapy with Spesolimab and Apremilast for Refractory Generalized Pustular Psoriasis: A Case Report
Provisionally accepted
- 1Department of Dermatology, Tangdu Hospital, Fourth Military Medical University, xi'an, China
- 2Department of Urology, Tangdu Hospital, Fourth Military Medical University, xi'an, China
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Generalized pustular psoriasis (GPP) is a rare, life-threatening neutrophilic dermatosis characterized by recurrent episodes of widespread sterile pustules, systemic inflammation, and potential multi-organ failure. We present a 75-year-old woman with a 10-year history of GPP refractory to conventional therapies, including cyclosporine, tripterygium glycosides, and acitretin. Following initial spesolimab infusions that controlled acute flares but failed to prevent relapse, a sequential therapeutic strategy was initiated: a single 900-mg intravenous dose of spesolimab followed by adjunctive apremilast (30 mg twice daily). Within 36 hours, her fever subsided ( from 39°C to 36.5°C), and pustules resolved completely within one week. Notably, apremilast monotherapy maintained sustained remission for 13 months after spesolimab discontinuation, with no adverse events observed. The patient reported significantly restored quality of life and satisfaction with the treatment. This case suggests that combining an anti-interleukin-36 (IL-36) inhibitor for acute control with phosphodiesterase 4 (PDE4) inhibition for maintenance may offer a promising strategy for refractory GPP, though larger studies are needed to validate this approach.
Keywords: generalized pustular psoriasis, spesolimab, Apremilast, IL-36 inhibitors, combination therapy
Received: 18 Jul 2025; Accepted: 18 Aug 2025.
Copyright: © 2025 Li, Li, Hu, Cao and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ling Liu, Department of Dermatology, Tangdu Hospital, Fourth Military Medical University, xi'an, China
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