Generalized Pustular Psoriasis Including Nail Psoriasis Successfully Treated with Gulsekumab: Case Report

We present a rare and potential life-threathning case of a 58-year-old man who came in with pruritic skin lesions that were intensively painful, small erythematous pustules that were sterile and scaly, located on both upper and lower extremities and lower back that gradually increased and spread to the limbs, trunk, face and scalp, alongside he was with nail thickening, yellow and white nail discoloration and onycholysis.These symptoms had persisted for over 20 years with multiple recurrences at different times.Despite past treatments with conventional treatments, the patient's symptoms worsened over time in several episodes.Initial lab results and clinical presentations were consistent with generalized pustular psoriasis (GPP) with nail psoriasis.The patient was initiated on Guselkumab (Tremfya), a subcutaneous IL-23 monoclonal antibody inhibitor, along with other medications for symptomatic relief.During a total of 10 visits within 18 months, the patient's symptoms dramatically improved, with the nail psoriasis largely resolved with no rebound of symptoms, and the therapy was effectively tolerated with no negative side effects reported.This rare case demonstrates the efficacy of Guselkumab subcutaneous injection in the treatment of GPP and nail psoriasis, indicating that it could be an effective therapeutic choice in other cases like this.