Clinical Issues™ in Psoriasis

Faculty

Jeffrey J. Crowley, MD
Bakersfield Dermatology and Skin Cancer Medical Center
Bakersfield, California

Abby S. Van Voorhees, MD
Chair, Department of Dermatology
Eastern Virginia Medical School
Norfolk, Virginia 

Target Audience

The educational design of this activity addresses the needs of dermatologists, clinical immunologists, and other clinicians involved in the treatment and management of patients with pustular psoriasis.

Educational Objectives

After completing this activity, the participant should be better able to:

• Describe the genetic and pathophysiologic mechanisms that contribute to the development of pustular psoriasis including factors that have informed the development of new therapies
• Comprehensively assess patients with suspected pustular psoriasis based on clinical manifestations, diagnostic criteria, and disease severity
• Describe the mechanistic rationales and clinical evidence for current and emerging biologic therapies for the treatment of generalized pustular psoriasis and palmoplantar pustulosis
• Individualize therapeutic regimens for pustular psoriasis, with a focus on generalized disease subtypes and palmoplantar pustulosis

Program Overview

Pustular psoriasis is a relatively rare form of psoriasis and has historically been classified into generalized and localized forms of the disease.¹ Generalized pustular psoriasis is characterized by widespread sterile pustules on erythematous skin, recurrent fever, and systemic flushing and malaise.^1,2 Palmoplantar pustulosis, a localized form, is characterized by erythema, pruritis, burning, and pain on the palms and soles. Recent evidence suggests that IL36RN mutations are the most common genetic aberration linked to pustular psoriasis, with the allelic frequency distinguishing generalized pustular psoriasis and palmoplantar pustulosis; the former shows a 4 to 1 increase versus the latter.³ Whether pustular psoriasis presents as localized or generalized, patients are subject to significant health risks and poor quality of life outcomes due to both skin and systemic manifestations. Patients may be subject to delays in diagnosis, in part because the disease states are relatively rare and there are little solid epidemiologic data.⁴ Dermatologists are faced with limited guidance on selecting therapies for patients with any of the pustular psoriasis subtypes.¹ Biologic agents for pustular psoriasis and palmoplantar pustulosis are being examined in clinical trials. These include some biologics approved for psoriasis as well as agents with novel therapeutic targets, such as an anti-interleukin (IL)-36 receptor antibody.⁵ This Clinical Issues enduring activity will use both lecture and faculty discussion among leading dermatology experts to explore many of these issues, with an emphasis on evolving diagnostic and management strategies for generalized pustular psoriasis and palmoplantar pustulosis.

References

1. Robinson A, Van Voorhees AS, Hsu S, et al. Treatment of pustular psoriasis: from the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol. 2012;67(2):279-288.
2. 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 Dermatol. 2018;45(11):1235-1270.
3. Twelves S, Mostafa A, Dand N, et al. Clinical and genetic differences between pustular psoriasis subtypes. J Allergy Clin Immunol. 2018. [Epub ahead of print.]
4. Benjegerdes KE, Hyde K, Kivelevitch D, Mansouri B. Pustular psoriasis: pathophysiology and current treatment perspectives. Psoriasis (Auckl). 2016;6:131-144.
5. Bachelez H, Choon S, Marrakchi S, et al. Efficacy and safety of BI 655130, an anti-interleukin-36 receptor antibody, in patients with acute generalized pustular psoriasis. Abstract D3T01.1E. EADV Congress; September 12-16, 2018; Paris, France.

Physician Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Clinical and Patient Educators Association (CPEA) and Integritas.  CPEA is accredited by the ACCME to provide continuing medical education for physicians.

* This CME/CE activity complies with all requirements of the federal Physician Payment Sunshine Act. If a reportable event is associated with this activity, the accredited provider managing the program will provide the appropriate physician data to the Open Payments database.

Physician Credit Designation

Clinical and Patient Educators Association designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 Credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CPEA Contact Information

For information about the accreditation of this program, please contact CPEA at 303-953-4580 or cme@cpea-assn.org.

Instructions to Receive Credit

In order to receive credit for this activity, the participant must complete the posttest and program evaluation. Your post-test will automatically be graded. If you successfully complete the posttest (score of 80% or higher), your statement of participation will be made available immediately. Click on the View Statement of Participation link and print the statement for your records. If you receive a score lower than 80%, you will receive a message notifying you that you did not pass the posttest. You will have 2 opportunities to pass the posttest.

For information about the accreditation of this program, please contact CPEA at 303-953-4580 or cme@cpea-assn.org.

Fee Information & Refund/Cancellation Policy

There is no fee for this educational activity.

Disclosure of Conflicts of Interest

Clinical and Patient Educators Association (CPEA) requires instructors, planners, managers, and other individuals and their spouses/life partners who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by CPEA for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.

The faculty reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME activity:

Jeffrey J. Crowley, MD

Consultant/Independent Contractor: AbbVie Inc., Eli Lilly and Company, Janssen Therapeutics, Novartis Pharmaceuticals Corporation; Grant/ Research Support: AbbVie Inc., Eli Lilly and Company, Janssen Therapeutics, Merck & Co., Inc., MC2 Therapeutics A/S, Novartis Pharmaceuticals Corporation, Regeneron Pharmaceuticals, Inc., Verrica Pharmaceuticals Inc., UCB, Inc.; Speakers Bureau: AbbVie Inc., Eli Lilly and Company, Janssen Therapeutics, Sun Pharmaceutical Industries, Inc., UCB, Inc.

Abby S. Van Voorhees, MD

Consultant/Independent Contractor: Celgene Corporation, Eli Lilly and Company, Novartis Pharmaceuticals Corporation, UCB, Inc.; Grant/Research Support: Celgene Corporation, Eli Lilly and Company; Honoraria: DermTech, Inc., WebMD

The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Andrea Funk
Nothing to disclose

Gabriela Villareal Levy MD, MPH
Nothing to disclose

Gena Dolson
Nothing to disclose

Jim Kappler, PhD
Nothing to disclose

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration. Clinical and Patient Educators Association (CPEA) and Integritas do not recommend the use of any agent outside of the labeled indications. 

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.