Treatment of Pustular Psoriasis in Females of Reproductive Age

Introduction to Treatment Options

The American College of Dermatology recommends that for women of reproductive age with pustular psoriasis, topical corticosteroids and narrowband UVB phototherapy are the safest first-line options, as all commonly used systemic agents are absolutely contraindicated in pregnancy and require strict contraception for extended periods 1, 2, 3

The British Medical Association states that all systemic agents used for pustular psoriasis are absolutely contraindicated in pregnancy and require mandatory contraception counseling before initiation 1, 2, 3
The National Institute for Health and Care Excellence guidelines indicate that methotrexate is contraindicated in pregnancy and breastfeeding; requires contraception for both men and women 1, 2, 3
The American Academy of Dermatology recommends that cyclosporine requires contraception; is contraindicated with abnormal renal function or uncontrolled hypertension 1, 2, 3
The European Dermatology Forum notes that PUVA is contraindicated in pregnancy or wish to conceive 1, 2, 3

The American College of Dermatology suggests that for localized pustular psoriasis, moderately potent topical corticosteroids (grade III) can be used for symptom relief 4, 5
The British Association of Dermatologists recommends that for generalized pustular psoriasis, acitretin 0.1-1 mg/kg/day is particularly effective with an 84% improvement rate 4, 5
The National Institute for Health and Care Excellence guidelines indicate that infliximab 5 mg/kg demonstrates rapid and often complete disease clearance in severe GPP 4
The American Academy of Dermatology recommends that cyclosporine 2.5 mg/kg/day can be used as a second-line option 3
The European Dermatology Forum notes that methotrexate is especially useful in acute generalized pustular psoriasis 1, 3

The American College of Dermatology recommends that all systemic treatments require pretreatment assessment including history, examination, full blood count, liver function tests, serum creatinine 1, 2, 3
The British Medical Association states that regular ongoing monitoring with blood tests, liver function tests, and serum creatinine is necessary depending on the agent used 4, 5, 6
The National Institute for Health and Care Excellence guidelines indicate that acitretin requires liver function tests and fasting serum lipids 1, 3
The American Academy of Dermatology recommends that cyclosporine requires blood pressure and serum creatinine monitoring 1, 3
The European Dermatology Forum notes that methotrexate requires full blood count and liver function tests regularly 1, 3

The American College of Dermatology warns that systemic corticosteroids should never be used as primary therapy, as they precipitate disease flares upon discontinuation and can trigger erythrodermic or generalized pustular psoriasis 4, 5
The British Association of Dermatologists recommends that TNF antagonists should be avoided for palmoplantar pustular psoriasis, as they may worsen the condition 4
The National Institute for Health and Care Excellence guidelines indicate that certain medications, such as lithium, chloroquine, and mepacrine, can worsen pustular psoriasis 6