Successful response in a case of severe pustular psoriasis after interleukin-1β inhibition

Br J Dermatol. 2017 Jan;176(1):212-215. doi: 10.1111/bjd.14685. Epub 2016 Oct 12.


Generalized pustular psoriasis (GPP) is a severe type of psoriasis accompanied by systemic and often life-threatening manifestations. The efficacy of the interleukin (IL)-1 antagonist anakinra in cases of GPP underscores the role of IL-1 in disease pathogenesis. We present a case of a middle-aged man who developed an abrupt and severe form of GPP with severe eosinophilia and cholestatic hepatitis. The patient received salvage treatment with a combination of glucocorticoids, hydroxyurea and imatinib, while administration of the IL-1 inhibitor anakinra resulted in remission of hepatitis and a significant skin improvement. However, due to persistent hypersensitivity skin reactions, anakinra was withdrawn and replaced with the anti-IL-1β antagonist canakinumab. As a result of canakinumab, the patient's skin completely cleared, while no systemic manifestations recurred. After 1 year of continuous canakinumab therapy, the patient remained virtually free of symptoms, while the drug was well tolerated.

Publication types

  • Case Reports

MeSH terms

  • Antibodies, Monoclonal / therapeutic use*
  • Antibodies, Monoclonal, Humanized
  • Dermatologic Agents / therapeutic use*
  • Humans
  • Interleukin 1 Receptor Antagonist Protein / therapeutic use*
  • Interleukin-1beta / antagonists & inhibitors*
  • Male
  • Middle Aged
  • Psoriasis / chemically induced
  • Psoriasis / drug therapy*
  • Treatment Outcome


  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Dermatologic Agents
  • Interleukin 1 Receptor Antagonist Protein
  • Interleukin-1beta
  • canakinumab