Targeting IL-17A for the treatment of pustular psoriasis: a comprehensive review

ABSTRACT

Introduction

Pustular psoriasis (PP) is a rare subtype of psoriasis. Overall, the growing evidence – in particular for acute generalized PP (GPP) – supports that it is a separate entity with a specific pathogenetic pathway. Interleukin (IL)-17/T-helper 17 (Th17) axis involvement may play an important role in the pathophysiology of PP. Biologicals, often required to achieve clinical remission, have changed the treatment of PP.

Areas covered

We provide the reader with an overview of all the available evidence on the use of the antibody-based therapy targeting IL-17A in patients with PP.

Expert opinion

Although papers reported in this review do not provide definitive evidence (due to methodological limitations) to support the use of IL-17 inhibitors as potential first-line for the treatment of PP, based on our own experience and according to most of the reported literature, targeting IL-17A, may represent the best therapeutical approach in this peculiar clinical spectrum of psoriasis.

KEYWORDS:

• IL-17A
• pustular psoriasis
• secukinumab
• ixekizumab
• brodalumab
• biologics
• acrodermatitis continua of Hallopeau
• acute generalized pustular psoriasis

Article highlights

• The advent of biologics during the last years has revolutionized the treatment of pustular psoriasis.

• Interleukin-17A pathway, as demonstrated by several experimental and clinical studies, may play an important role in the pathophysiology of pustular psoriasis.

• In the literature, successful clinical results have been reported with all the available anti-IL-17 molecules: secukinumab, ixekizumab, and brodalumab.

• There is a need for randomized studies to standardize the use of IL-17 inhibitors in this subset of patients. We propose these agents as the potential best therapeutical approach in this peculiar clinical spectrum of psoriasis.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.