SUCCESSFUL TREATMENT OF IMPETIGO HERPETIFORMIS WITH LOW-DOSE METHOTREXATE - IMPLICATIONS FOR THE PATHOGENESIS OF PSORIASIS

A generalized pustular psoriasis in pregnancy was first mentioned by H ebra. In the present work a classical fulminant course of pustular pso riasis is reported in a 23 year old primigravida. In spite of systemic treatment with methylprednisolone the course was progressive and each dose decrease of the glucocorticoids led to a new pustular episode. O nly low dose methotrexate therapy could control the disease. Even thou gh the pathogenesis of psoriasis has not been completely elucidated, i t is accepted that it is associated with certain HLA antigens, and tha t a central role is played by the activation of the T-lymphocytes and proinflammatory cytokines such as interleukin 1 (IL-1), interleukin 6 and interleukin 8. In a previous paper we have demonstrated that MTX a cts beyond its antiproliferative effect as an immunosuppressive agent by blocking IL-1. The rapid improvement in our patient with impetigo h erpetiformis was probably due to the IL-1 antagonism and less to its a ntiproliferative effect.