【开放获取】 儿童脓疱型银屑病诊疗中国专家共识（2025版）

doi:10.35541/cjd.20240714

Abstract

Abstract: 【Abstract】 Pustular psoriasis is a rare subtype of psoriasis, which belongs to the category of autoinflammatory diseases, clinically characterized by erythema and aseptic pustules that may be generalized or localized. Generalized pustular psoriasis is often accompanied by systemic symptoms and is known for its recurrent and prolonged nature. Management strategies for pediatric patients differ significantly from those for adults. Based on the latest Chinese and international consensus, guidelines, and considering the current diagnostic and treatment status in China, 13 key clinical issues related to diagnostic criteria for, clinical subtypes of, disease assessment, and therapeutic methods for pustular psoriasis in children were identified. Following discussions among the expert group, 33 evidence-based recommendations were developed to standardize the diagnosis and treatment of this disease, thereby providing guidance for clinical practice.

Key words: Psoriasis, Child, Pustular psoriasis, Diagnosis, Therapy, Consensus

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

References ［57］

［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]	Wang Li, Wang Qianqiu, Zhang Ruili. Research progress in latent syphilis [J]. Chinese Journal of Dermatology, 2026, 59(3): 286-289.
[2]	Liu Lihao, Hu Yu, Chen Kun. Clinical application and development of photobiomodulation in dermatology [J]. Chinese Journal of Dermatology, 2026, 59(3): 278-282.
[3]	Yang Wanqing, Chen Nuoran, Meng Xiaoqi, Liu Tingwei, Xu Yang. Application of focused ultrasound in dermatology beyond the anti?aging aspects [J]. Chinese Journal of Dermatology, 2026, 0(3): 20240433-e20240433.
[4]	Zeng Wanxin, Wen Xiang. Photoelectric therapy for hypertrophic scars [J]. Chinese Journal of Dermatology, 2026, 59(3): 269-273.
[5]	Zhu Yun, Wang Jiancai, Yang Ming, Gu Fei, Zhang Hongli, Gao Ying. Efficacy of 755-nm picosecond laser in the treatment of café-au-lait macules in children and analysis of its influencing factors [J]. Chinese Journal of Dermatology, 2026, 59(3): 224-229.
[6]	Xia Zhikuan, Ge Ge. Laser therapy for vitiligo: clinical applications and prospects [J]. Chinese Journal of Dermatology, 2026, 59(3): 213-217.
[7]	Committee on Psoriasis, Chinese Society of Dermatology. Expert consensus on management of psoriasis with comorbidities （2026） [J]. Chinese Journal of Dermatology, 2026, 59(3): 193-207.
[8]	Expert Group on the Interpretation of the "Chinese expert consensus on the clinical application of photobiomodulation therapy in dermatology （）", Laser Medicine Group, Chinese Society of Dermatology. Interpretation of the Chinese expert consensus on the clinical application of photobiomodulation therapy in dermatology （2025） [J]. Chinese Journal of Dermatology, 2026, 59(3): 208-212.
[9]	Wang Juncheng, Liu Jie. Artificial intelligence in psoriasis: diagnosis, treatment and patient management [J]. Chinese Journal of Dermatology, 2026, 0(3): 20240061-e20240061.
[10]	Xu Zhuohong, Zhou Huan, Hu Yu, Gu Heng. Balneotherapy in skin diseases [J]. Chinese Journal of Dermatology, 2026, 0(3): 20250531-e20250531.
[11]	Guo Lan, Jin Hongzhong. Tryptophan and arginine metabolism in immune regulation and their role in the pathogenesis of psoriasis [J]. Chinese Journal of Dermatology, 2026, 0(3): 20240377-e20240377.
[12]	Liu Jia, Gu Yinghua, He Xiaoning, . Treatment and disease burden of hereditary angioedema [J]. Chinese Journal of Dermatology, 2026, 59(3): 282-286.
[13]	Yan Kexin, Zhang Wei, Song Hao, Xu Xiulian. Application of nanomedicine in the diagnosis and treatment of melanoma [J]. Chinese Journal of Dermatology, 2026, 59(2): 189-192.
[14]	Chinese Society of Dermatology, China Dermatologist Association. Guidelines on the diagnosis and treatment of dermatitis and eczematous diseases in China （2026 edition） [J]. Chinese Journal of Dermatology, 2026, 59(2): 97-106.
[15]	Environmental and Occupational Skin Disease Research Group, Chinese Dermatovenerology Society of Integrative Medicine, Committee on Dermatology, Chinese Association of Geriatric Research, Committee on Drugs for Dermatology, China Association of Traditional Chinese Medicine, Dermatology Branch of China Association for Promotion of Health Science and Technology. Expert consensus on rational application of moisturizers for atopic dermatitis （2026 edition） [J]. Chinese Journal of Dermatology, 2026, 59(2): 107-112.

Expert consensus on the diagnosis and treatment of pediatric pustular psoriasis in China （2025 version）

PDF

Knowledge

Abstract

Cite this article

share this article

References ［57］

Related Articles 15

Metrics

Comments

Recommended 10