Case of generalized pustular psoriasis with end-stage renal disease successfully treated with granulocyte monocyte apheresis in combination with hemodialysis.

Granulocyte monocyte apheresis (GMA) is an extracorporeal apheresis instrument that removes activated neutrophils and monocytes. Generalized pustular psoriasis (GPP) is characterized by neutrophil infiltration into the epidermis that causes Kogoj's spongiotic pustule. Thus, GMA is one of the useful therapies for GPP, and it was approved for the treatment in 2012 in Japan. Herein, we report a case of GPP with end-stage renal disease (ESRD) successfully treated with GMA in combination with hemodialysis (HD). A 54-year-old Japanese female visited our outpatient clinic because of erythema with pustules on her trunk and extremities over the past 4 months. Histopathological examination showed an intraepidermal pustule filled with numerous neutrophils and spongiosis. These findings led to the diagnosis of GPP. She had ESRD and had been treated with HD twice a week for approximately 4 years. During maintenance HD twice a week, weekly GMA was started at Tokai University Hospital. The skin symptoms disappeared after five administrations of GMA. We suggest that GMA is an effective therapy for GPP patients with ESRD who are treated with HD.

Which anti-histamines dermatological specialists select in their therapies for common skin diseases? A practical analysis from multiple clinics.

In the treatment of skin diseases, antihistamines and antiallergic agents are among the most frequently used oral medications, and are available as a wide variety of products. We investigated what criteria dermatological specialists use to select antihistamines and antiallergic agents, as well as the use objectives and expected benefits. The present investigation was conducted in a total of 1448 patients, including 336 patients with urticaria, 944 patients with eczema/dermatitis, and 199 patients with atopic dermatitis, in 6 dermatological clinics and 1 university hospital. A Case Card to record the prescription motives and clinical evaluation was used, and the results were tabulated and analyzed. As a result, it was found that the expected result was obtained in more than 80% of cases prescribed for by dermatologists based on the prescription motives for individual cases.