中华皮肤科杂志 ›› 2025, Vol. 58 ›› Issue (4): 297-306.doi: 10.35541/cjd.20240714
中国医师协会皮肤科医师分会儿童学组 中华医学会皮肤性病学分会银屑病学组
收稿日期:
2024-12-25
修回日期:
2025-01-27
发布日期:
2025-04-03
通讯作者:
徐子刚;王华;王刚
E-mail:zigangxupek@163.com; huawang@hospital.cqmu.edu.cn; xjwgang@fmmu.edu.cn
基金资助:
Group on Pediatric Dermatology, China Dermatologist Association; Committee on Psoriasis, Chinese Society of Dermatology
Received:
2024-12-25
Revised:
2025-01-27
Published:
2025-04-03
Contact:
Xu Zigang; Wang Hua; Wang Gang
E-mail:zigangxupek@163.com; huawang@hospital.cqmu.edu.cn; xjwgang@fmmu.edu.cn
Supported by:
摘要: 【摘要】 脓疱型银屑病是一种罕见的银屑病亚型,属于自身炎症性疾病范畴,临床以泛发或局限分布的红斑及无菌性脓疱为特征,泛发性脓疱型银屑病常伴有系统症状,病情反复、迁延。儿童作为高发人群,管理策略与成人有所区别。本共识综合国内外诊疗进展,结合我国现状,针对儿童脓疱型银屑病的诊断、临床亚型、疾病评估及治疗方法,共遴选了13个临床较为关注的问题,经专家组共同讨论最终形成33条循证推荐意见,旨在提升该病的规范化诊治水平,并为临床实践提供指导。
中国医师协会皮肤科医师分会儿童学组 中华医学会皮肤性病学分会银屑病学组. 【开放获取】 儿童脓疱型银屑病诊疗中国专家共识(2025版)[J]. 中华皮肤科杂志, 2025,58(4):297-306. doi:10.35541/cjd.20240714
Group on Pediatric Dermatology, China Dermatologist Association, Committee on Psoriasis, Chinese Society of Dermatology. Expert consensus on the diagnosis and treatment of pediatric pustular psoriasis in China (2025 version)[J]. Chinese Journal of Dermatology, 2025, 58(4): 297-306.doi:10.35541/cjd.20240714
[1] | 全国银屑病流行调查组. 全国1984年银屑病流行调查报告[J]. 中华皮肤科杂志, 1986,19(5):253⁃261. |
[2] | Feng JN, Guo JZ, Zhang Q, et al. Higher prevalence of generalized pustular psoriasis in Asia? A population⁃based study using claim data in China and a systematic review[J]. Dermatology, 2023,239(2):195⁃205. doi: 10.1159/000528850. |
[3] | Wang Z, Xiang X, Chen Y, et al. Different clinical features of pediatric generalized pustular psoriasis in patients with or without IL36RN variants[J]. Dermatology, 2023,239(2):217⁃226. doi: 10.1159/000528753. |
[4] | Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (2022 report) [EB/OL].(2021‑11‑22) [2024‑01‑12]. https: //goldcopd.org/. |
[5] | Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations[J]. BMJ, 2008,336(7650):924⁃926. doi: 10. 1136/bmj.39489.470347.AD. |
[6] | Navarini AA, Burden AD, Capon F, et al. European consensus statement on phenotypes of pustular psoriasis[J]. J Eur Acad Dermatol Venereol, 2017,31(11):1792⁃1799. doi: 10.1111/jdv. 14386. |
[7] | Smith MP, Ly K, Thibodeaux Q, et al. Acrodermatitis continua of Hallopeau: clinical perspectives[J]. Psoriasis (Auckl), 2019,9:65⁃72. doi: 10.2147/PTT.S180608. |
[8] | Mitra D, Bhatnagar A, Kumar M. Acrodermatitis continua of hallopeau: a diagnostic challenge[J]. Indian Dermatol Online J, 2023,14(1):91⁃93. doi: 10.4103/idoj.idoj_312_22. |
[9] | 《脓疱型银屑病诊疗中国专家共识(2022版)》编写委员会专家组. 脓疱型银屑病诊疗中国专家共识(2022版)[J]. 中华皮肤科杂志, 2022,55(3):187⁃195. doi: 10.35541/cjd.20210698. |
[10] | Puig L, Choon SE, Gottlieb AB, et al. Generalized pustular psoriasis: a global Delphi consensus on clinical course, diagnosis, treatment goals and disease management[J]. J Eur Acad Dermatol Venereol, 2023,37(4):737⁃752. doi: 10.1111/jdv.18851. |
[11] | Choon SE, van de Kerkhof P, Gudjonsson JE, et al. International consensus definition and diagnostic criteria for generalized pustular psoriasis from the international psoriasis council[J]. JAMA Dermatol, 2024,160(7):758⁃768. doi: 10.1001/jamadermatol. 2024.0915. |
[12] | Fujita H, Terui T, Hayama K, et al. Japanese guidelines for the management and treatment of generalized pustular psoriasis: The new pathogenesis and treatment of GPP[J]. J Dermatol, 2018,45(11):1235⁃1270. doi: 10.1111/1346⁃8138.14523. |
[13] | Costanzo A, Bardazzi F, DE Simone C, et al. Pustular psoriasis with a focus on generalized pustular psoriasis: classification and diagnostic criteria. An Italian expert consensus[J]. Ital J Dermatol Venerol, 2022,157(6):489⁃496. doi: 10.23736/S2784⁃8671.22.07415⁃1. |
[14] | 中华医学会皮肤性病学分会银屑病专业委员会. 中国银屑病诊疗指南(2023版)[J]. 中华皮肤科杂志, 2023,56(7):573⁃625. doi: 10.35541/cjd.20220839. |
[15] | Li M, Han J, Lu Z, et al. Prevalent and rare mutations in IL⁃36RN gene in Chinese patients with generalized pustular psoriasis and psoriasis vulgaris[J]. J Invest Dermatol, 2013,133(11):2637⁃2639. doi: 10.1038/jid.2013.267. |
[16] | Twelves S, Mostafa A, Dand N, et al. Clinical and genetic differences between pustular psoriasis subtypes[J]. J Allergy Clin Immunol, 2019,143(3):1021⁃1026. doi: 10.1016/j.jaci.2018. 06.038. |
[17] | Choon SE, Tok P, Wong KW, et al. Clinical profile of patients with acute generalized pustular psoriasis with and without IL36RN mutations in multi⁃ethnic Johor Bahru, Malaysia[J]. Exp Dermatol, 2023,32(8):1263⁃1271. doi: 10.1111/exd.14776. |
[18] | Menter A, Cordoro KM, Davis D, et al. Joint American Academy of Dermatology⁃National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis in pediatric patients[J]. J Am Acad Dermatol, 2020,82(1):161⁃201. doi: 10.1016/j.jaad.2019.08.049. |
[19] | Hua S, Liu J, Fang B, et al. Novel splice site mutation at the C⁃terminal of SPINK5 cause a unique Netherton syndrome phenotype mimicking pustular psoriasis[J]. J Eur Acad Dermatol Venereol, 2023,37(1):e113⁃e115. doi: 10.1111/jdv. 18606. |
[20] | Kishimoto M, Taniguchi Y, Tsuji S, et al. SAPHO syndrome and pustulotic arthro⁃osteitis[J]. Mod Rheumatol, 2022,32(4):665⁃674. doi: 10.1093/mr/roab103. |
[21] | Chen BL, Liu QW, Dong XW, et al. Biologics for generalized pustular psoriasis: a systematic review and single⁃arm meta⁃analysis[J]. Front Immunol, 2024,15:1462158. doi: 10.3389/fimmu.2024.1462158. |
[22] | Burden AD, Choon SE, Gottlieb AB, et al. Clinical disease measures in generalized pustular psoriasis[J]. Am J Clin Dermatol, 2022,23(Suppl 1):39⁃50. doi: 10.1007/s40257⁃021⁃00653⁃0. |
[23] | Bhushan M, Burden AD, McElhone K, et al. Oral liarozole in the treatment of palmoplantar pustular psoriasis: a randomized, double⁃blind, placebo⁃controlled study[J]. Br J Dermatol, 2001,145(4):546⁃553. doi: 10.1046/j.1365⁃2133.2001.04411.x. |
[24] | Huang IH, Wu PC, Chiu HY, et al. Small⁃molecule inhibitors and biologics for palmoplantar psoriasis and palmoplantar pustulosis: a systematic review and network meta⁃analysis[J]. Am J Clin Dermatol, 2024,25(3):347⁃358. doi: 10.1007/s40257⁃024⁃00849⁃0. |
[25] | Krueger J, Puig L, Thaçi D. Treatment options and goals for patients with generalized pustular psoriasis[J]. Am J Clin Dermatol, 2022,23(Suppl 1):51⁃64. doi: 10.1007/s40257⁃021⁃00658⁃9. |
[26] | van Geel MJ, Mul K, Oostveen AM, et al. Calcipotriol/betamethasone dipropionate ointment in mild⁃to⁃moderate paediatric psoriasis: long⁃term daily clinical practice data in a prospective cohort[J]. Br J Dermatol, 2014,171(2):363⁃369. doi: 10.1111/bjd.12895. |
[27] | Eisert L, Augustin M, Bach S, et al. S2k guidelines for the treatment of psoriasis in children and adolescents ⁃ short version part 1[J]. J Dtsch Dermatol Ges, 2019,17(8):856⁃870. doi: 10.1111/ddg.13907. |
[28] | Ruggiero A, Patruno C, Napolitano M, et al. Etanercept for pediatric acrodermatitis continua of Hallopeau: a case report and literature review[J]. Dermatol Ther, 2020,33(6):e14046. doi: 10.1111/dth.14046. |
[29] | Wang Z, Xiang X, Chen Y, et al. Treating paediatric acrodermatitis continua of Hallopeau with adalimumab: a case series[J]. Clin Exp Dermatol, 2022,47(1):195⁃196. doi: 10. 1111/ced.14890. |
[30] | Bachelez H, Choon SE, Marrakchi S, et al. Trial of spesolimab for generalized pustular psoriasis[J]. N Engl J Med, 2021,385(26):2431⁃2440. doi: 10.1056/NEJMoa2111563. |
[31] | Bellinato F, Gisondi P, Dattola A, et al. Spesolimab in patients with flare of generalized pustular psoriasis: a multicentre case⁃series[J]. J Eur Acad Dermatol Venereol, 2024,38(5):e437⁃e439. doi: 10.1111/jdv.19678. |
[32] | Cardenas⁃de la Garza JA, Zazueta⁃López RM, Garza⁃Elizondo AK, et al. Spesolimab treatment in a patient with generalized pustular psoriasis: a case report with 12⁃month follow⁃up and literature review[J]. Clin Exp Dermatol, 2024,49(3):286⁃288. doi: 10.1093/ced/llad389. |
[33] | Chen Y, Wang Z, Liang Y, et al. Successful treatment of pediatric generalized pustular psoriasis (GPP) with spesolimab: 5 case reports and evaluations of circulating IL⁃36 levels[J]. J Inflamm Res, 2024,17:8199⁃8206. doi: 10.2147/JIR.S485077. |
[34] | Wang Y, Zhang L, Zheng J, et al. Spesolimab response in a girl with acrodermatitis continua of Hallopeau[J]. JAMA Dermatol, 2024,160(4):476⁃477. doi: 10.1001/jamadermatol.2023.6349. |
[35] | Cai L, Yan Y, Li Y, et al. Spesolimab in refractory paediatric acrodermatitis continua of Hallopeau, a case series[J]. J Eur Acad Dermatol Venereol, 2024. doi: 10.1111/jdv.20500. |
[36] | López⁃Sánchez C, Falla LM, Roé⁃Crespo E, et al. Excellent response to secukinumab in an infant with severe generalized pustular psoriasis[J]. J Dermatol, 2021,48(6):907⁃910. doi: 10.1111/1346⁃8138.15673. |
[37] | Miao C, Chen Y, Wang Z, et al. Real⁃world data on the use of secukinumab and acitretin in pediatric generalized pustular psoriasis[J]. J Dermatol, 2023,50(2):258⁃261. doi: 10.1111/1346⁃8138.16551. |
[38] | Bonekamp N, Caorsi R, Viglizzo GM, et al. High⁃dose ustekinumab for severe childhood deficiency of interleukin⁃36 receptor antagonist (DITRA)[J]. Ann Rheum Dis, 2018,77(8):1241⁃1243. doi: 10.1136/annrheumdis⁃2017⁃211805. |
[39] | Chen Y, Wang Z, Miao C, et al. Etanercept: a viable treatment option for young children with generalized pustular psoriasis[J]. Pediatr Investig, 2024,8(4):295⁃298. doi: 10.1002/ped4.12448. |
[40] | Du Y, Yan Q, Chen M, et al. Efficacy of adalimumab in pediatric generalized pustular psoriasis: case series and literature review[J]. J Dermatolog Treat, 2022,33(6):2862⁃2868. doi: 10.1080/09546634.2022.2089327. |
[41] | Hospach T, Glowatzki F, Blankenburg F, et al. Scoping review of biological treatment of deficiency of interleukin⁃36 receptor antagonist (DITRA) in children and adolescents[J]. Pediatr Rheumatol Online J, 2019,17(1):37. doi: 10.1186/s12969⁃019⁃0338⁃1. |
[42] | 中华医学会皮肤性病学分会儿童学组,中国医师协会皮肤科医师分会儿童皮肤病学组. 中国儿童银屑病生物治疗专家共识(2021)[J].中华皮肤科杂志, 2021,54(11):943⁃950. doi: 10.35541/cjd.20210547. |
[43] | Chen P, Li C, Xue R, et al. Efficacy and safety of acitretin monotherapy in children with pustular psoriasis: results from 15 cases and a literature review[J]. J Dermatolog Treat, 2018,29(4):353⁃363. doi: 10.1080/09546634.2017.1395798. |
[44] | Srivatsa S, Boswell JS, Mully TW. Infantile pustular psoriasis: Case report of successful treatment with acitretin in a 4⁃week⁃old infant[J]. JAAD Case Rep, 2021,11:121⁃123. doi: 10.1016/j.jdcr.2021.03.038. |
[45] | Gallo E, Llamas⁃Velasco M, Daudén E, et al. Refractory generalized pustular psoriasis responsive to a combination of adalimumab and acitretin[J]. Int J Dermatol, 2013,52(12):1610⁃1611. doi: 10.1111/j.1365⁃4632.2012.05472.x. |
[46] | Wang Y, Cheng R, Lu Z, et al. Clinical profiles of pediatric patients with GPP alone and with different IL36RN genotypes[J]. J Dermatol Sci, 2017,85(3):235⁃240. doi: 10.1016/j.jdermsci.2016.11.008. |
[47] | Halverstam CP, Zeichner J, Lebwohl M. Lack of significant skeletal changes after long⁃term, low⁃dose retinoid therapy: case report and review of the literature[J]. J Cutan Med Surg, 2006,10(6):291⁃299. doi: 10.2310/7750.2006.00065. |
[48] | 王雅辰, 王召阳, 向欣, 等. 口服阿维A对106例儿童身高和骨骼发育影响的回顾性分析[J]. 中华皮肤科杂志, 2022,55(12):1073⁃1077. doi: 10.35541/cjd.20220193. |
[49] | Kiliç SS, Hacimustafaoğlu M, Celebi S, et al. Low dose cyclosporin A treatment in generalized pustular psoriasis[J]. Pediatr Dermatol, 2001,18(3):246⁃248. doi: 10.1046/j.1525⁃1470.2001.018003246.x. |
[50] | Kim HS, Kim GM, Kim SY. Two⁃stage therapy for childhood generalized pustular psoriasis: low⁃dose cyclosporin for induction and maintenance with acitretin/narrowband ultraviolet B phototherapy[J]. Pediatr Dermatol, 2006,23(3):306⁃308. doi: 10.1111/j.1525⁃1470.2006.00247.x. |
[51] | Takahashi M, Takeuchi M, Matsunaga K. Infant with generalized pustular psoriasis who responded to cyclosporin A therapy[J]. J Dermatol, 2015,42(9):911⁃913. doi: 10.1111/1346⁃8138.12960. |
[52] | Kumar B, Dhar S, Handa S, et al. Methotrexate in childhood psoriasis[J]. Pediatr Dermatol, 1994,11(3):271⁃273. doi: 10.1111/j.1525⁃1470.1994.tb00602.x. |
[53] | Wang Z, Chen Y, Xiang X, et al. Systemic methotrexate treatment in 42 children with severe plaque psoriasis: a retrospective study in China[J]. Dermatology, 2022,238(5):919⁃927. doi: 10.1159/000521262. |
[54] | Dogra S, Kumaran MS, Handa S, et al. Methotrexate for generalized pustular psoriasis in a 2⁃year⁃old child[J]. Pediatr Dermatol, 2005,22(1):85⁃86. doi: 10.1111/j.1525⁃1470.2005. 22122.x. |
[55] | Skrabl⁃Baumgartner A, Weger W, Salmhofer W, et al. Childhood generalized pustular psoriasis: longtime remission with combined infliximab and methotrexate treatment[J]. Pediatr Dermatol, 2015,32(1):e13⁃e14. doi: 10.1111/pde.12457. |
[56] | Garg T, Chander R, Mittal S. Familial juvenile generalized pustular psoriasis: response to methotrexate[J]. Skinmed, 2011,9(3):190⁃191. |
[57] | Morita A, Strober B, Burden A D, et al. Efficacy and safety of subcutaneous spesolimab for the prevention of generalised pustular psoriasis flares (Effisayil 2): an international, multicentre, randomised, placebo⁃controlled trial[J]. The Lancet, 2023,402(10412):1541⁃1551. doi: 10.1016/S0140⁃6736(23)01378⁃8. |
[1] | 包诗杰 韩梅 周小勇. 基于文献回顾的依那西普治疗中毒性表皮坏死松解症疗效影响因素分析[J]. 中华皮肤科杂志, 2025, 58(4): 352-355. |
[2] | 万勇军 杨海晶 严翘 陈梅 王逢源 粟倩雅 董正邦 王飞. 免疫检查点抑制剂相关Stevens-Johnson综合征/中毒性表皮坏死松解症9例临床及预后分析[J]. 中华皮肤科杂志, 2025, 58(4): 347-351. |
[3] | 何春霞 晋红中. 【开放获取】 急危重皮肤病的诊疗原则、现状、挑战和展望[J]. 中华皮肤科杂志, 2025, 58(4): 307-314. |
[4] | 木葵 郭慧 文海泉 龙海 刘昱 罗帅寒天 黄馨 周星雨 肖嵘 李亚萍. 基于标准治疗联合泰它西普治疗25例系统性红斑狼疮的疗效和安全性分析[J]. 中华皮肤科杂志, 2025, 58(4): 322-327. |
[5] | 中华医学会皮肤性病学分会 中国医师协会皮肤科医师分会 中国医疗保健国际交流促进会皮肤医学分会 中国罕见病联盟皮肤罕见病专业委员会 国家皮肤与免疫疾病临床医学研究中心. 【开放获取】 副肿瘤性天疱疮诊疗中国专家共识(2025版)[J]. 中华皮肤科杂志, 2025, 58(4): 289-296. |
[6] | 中华医学会皮肤性病学分会儿童学组 中华医学会儿科学分会皮肤性病学组 中国康复医学会皮肤病康复专业委员会 中国医师协会皮肤科医师分会儿童皮肤病学组. [开放获取] 中国儿童特应性皮炎专病门诊建设及标准化病案管理专家共识(2025版)[J]. 中华皮肤科杂志, 2025, 0(4): 20240338-e20240338. |
[7] | 中华医学会皮肤性病学分会 中国医师协会皮肤科医师分会. [开放获取] 特应性皮炎达标门诊建设标准专家共识(2025基层版)[J]. 中华皮肤科杂志, 2025, 0(4): 20240296-e20240296. |
[8] | 李紫钰 鲁严. 关注新型冠状病毒感染后重症皮肤病[J]. 中华皮肤科杂志, 2025, 58(4): 378-383. |
[9] | 许秋云 纪超. 坏疽性脓皮病系统合并症的研究进展[J]. 中华皮肤科杂志, 2025, 58(4): 369-373. |
[10] | 吕铭悦 满孝勇. 细胞治疗在系统性红斑狼疮中的应用[J]. 中华皮肤科杂志, 2025, 58(4): 374-377. |
[11] | 秦蓓 李钦峰. 蓝莓松饼婴儿病因学研究进展[J]. 中华皮肤科杂志, 2025, 0(3): 20220411-e20220411. |
[12] | 许焯红 胡煜 顾恒. 间充质干细胞来源的外泌体在皮肤病中的作用[J]. 中华皮肤科杂志, 2025, 0(3): 20220881-e20220881. |
[13] | 袁勇勇 潘萌. 家族性慢性良性天疱疮研究进展[J]. 中华皮肤科杂志, 2025, 0(3): 20240182-e20240182. |
[14] | 叶慧 邓仕琳 梁景耀 张锡宝. 特应性皮炎复发控制与组织驻留记忆性T细胞的相关性研究进展[J]. 中华皮肤科杂志, 2025, 0(3): 20240192-e20240192. |
[15] | 李翔倩 张建中 周城. 系统小分子药物和生物制剂治疗斑秃的临床研究进展[J]. 中华皮肤科杂志, 2025, 0(3): 20240247-e20240247. |
|