Generalized Pustular Psoriasis pada Pasien Diabetes Melitus Tipe 2
(Case Report)
DOI:
https://doi.org/10.55606/jurrike.v5i1.8464Keywords:
Generalized Pustular Psoriasis, Inflammatory Mediators, Insulin Resistance, T2DM, TreatmentAbstract
Generalized pustular psoriasis (GPP) is a severe inflammatory form of psoriasis characterized by widespread sterile pustular eruptions. Pro-inflammatory mediators released during chronic inflammation may contribute to comorbidities, including type 2 diabetes mellitus (T2DM). A 65-year-old woman presented with pustular eruptions over almost the entire body for seven days, accompanied by burning sensation and pruritus. Some pustules coalesced forming “lakes of pus,” while others appeared as erythematous plaques with coarse white scales. The patient had a history of T2DM. Based on clinical findings, the patient was diagnosed with GPP. She was hospitalized for seven days and followed up weekly until week 10. Inflammatory mediators such as Th-1, TNF-α, IL-6, IL-7, IL-8, IL-17, and IL-23 in psoriasis may inhibit insulin receptor signaling and glucose uptake, leading to insulin resistance and increased blood glucose levels. The duration of treatment until remission in psoriasis patients with T2DM tends to be longer than in non-diabetic patients. In patients with comorbidities, low-dose methotrexate (5–7.5 mg/week) was administered. The coexistence of GPP and T2DM may lead to more severe exacerbations, prolonged treatment duration, and reduced quality of life, posing challenges in management.
Downloads
References
Adiguna, M. S., Wardhana, M., & Rahardjo, F. N. (2018). The positive correlation between psoriasis vulgaris severity degree with HbA1C level. BDV, 1(2), 28-31. https://doi.org/10.15562/bdv.v1i2.11
Bachelez, H. (2018). Pustular psoriasis and related pustular skin diseases. The British Journal of Dermatology, 178(3), 614-618. https://doi.org/10.1111/bjd.16232
Baran, W., Batycka-Baran, A., Zychowska, M., Bieniek, A., & Szepietowski, J. C. (2014). Folate supplementation reduces the side effects of methotrexate therapy for psoriasis. Expert Opinion on Drug Safety, 13(8), 1015-1021. https://doi.org/10.1517/14740338.2014.933805
Burden, A. D., Choon, S. E., Gottlieb, A. B., Navarini, A. A., & Warren, R. B. (2022). Clinical disease measures in generalized pustular psoriasis. American Journal of Clinical Dermatology, 23(Suppl 1), 39-50. https://doi.org/10.1007/s40257-021-00653-0
Carrascosa, J. M., De La Cueva, P., Ara, M., Puig, L., Bordas, X., Carretero, G., Ferrándiz, L., Sánchez-Carazo, J. L., Daudén, E., López-Estebaranz, J. L., Vidal, D., Herranz, P., Jorquera, E., Coto-Segura, P., & Ribera, M. (2016). Methotrexate in moderate to severe psoriasis: Review of the literature and expert recommendations. Actas Dermo-Sifiliográficas, 107(3), 194-206. https://doi.org/10.1016/j.ad.2015.10.005
Chiu, H., Hung, C., M, C., Fan, K., & Sung, F. (2020). The bidirectional association between type 2 diabetes and psoriasis: Two retrospective cohort studies. Indian Journal of Dermatology, Venereology and Leprology, 84(1), 6-15. https://doi.org/10.4103/ijdvl.IJDVL
Czarnecka-Operacz, M., & Sadowska-Przytocka, A. (2014). The possibilities and principles of methotrexate treatment of psoriasis - the updated knowledge. Postępy Dermatologii i Alergologii, 31(6), 392-400. https://doi.org/10.5114/pdia.2014.47121
De Luca, D. A., Papara, C., Hawro, T., & Thaçi, D. (2025). Psoriasis and diabetes: A review of the pathophysiological and therapeutic interconnections. Minerva Medica, 116(3), 195-222. https://doi.org/10.23736/S0026-4806.24.09570-3
Fadilla, Y., Febrina, D., Haryati, N. S., Suwarsa, O., & Darmadji, H. P. (2019). Psoriasis pustulosa generalisata dan pemfigus foliaseus pada seorang pasien yang diterapi dengan kombinasi metotreksat dan azatioprin. Media Dermato-Venereologica Indonesiana, 45(1), 33-41. https://doi.org/10.33820/mdvi.v45i1.15
Fadillah, L., Sofyan, A., & Hidayat, N. (2019). Laporan kasus: Psoriasis pustulosa generalisata dengan kejadian berulang yang diinduksi alergen. Jurnal Medical Profession (MedPro), 1(1), 50.
Grace, L. S., Djawad, K., Adam, A. M., & Kadir, D. (2019). Psoriasis pustular generalisata yang diterapi dengan kortikosteroid sistemik. J. Kedokt Meditek, 23(64), 57-65.
Hao, Y., Zhu, Y.-J., Zou, S., Zhou, P., Hu, Y.-W., Zhao, Q.-X., Gu, L.-N., Zhang, H.-Z., Wang, Z., & Li, J. (2021). Metabolic syndrome and psoriasis: Mechanisms and future directions. Frontiers in Immunology, 12, 711060. https://doi.org/10.3389/fimmu.2021.711060
Kristiani, F. S., & Anggraini, D. I. (2020). Psoriasis pustulosa generalisata: Tinjauan kasus pada geriatri. Medula, 9(4), 692-698.
Lodén, M. (2003). Role of topical emollients and moisturizers in the treatment of dry skin barrier disorders. American Journal of Clinical Dermatology, 4(11), 771-788. https://doi.org/10.2165/00128071-200304110-00005
Muanda, F. T., Blake, P. G., Weir, M. A., Ahmadi, F., McArthur, E., Sontrop, J. M., Urquhart, B. L., Kim, R. B., & Garg, A. X. (2023). Low-dose methotrexate and serious adverse events among older adults with chronic kidney disease. JAMA Network Open, 6(11), E2345132. https://doi.org/10.1001/jamanetworkopen.2023.45132
Shen, S., O'Brien, T., Yap, L. M., Prince, H. M., & McCormack, C. J. (2012). The use of methotrexate in dermatology: A review. Australasian Journal of Dermatology, 53(1), 1-18. https://doi.org/10.1111/j.1440-0960.2011.00839.x
Surjit, S., Sunil, D., Nusrat, S., Anil, B., & Samir, M. (2017). Prevalence of metabolic syndrome in psoriasis and levels of interleukin-6 and tumor necrosis factor-α in psoriasis patients with metabolic syndrome: Indian tertiary care hospital study. International Journal of Applied and Basic Medical Research, 2019(November), 193-195. https://doi.org/10.4103/ijabmr.IJABMR
van Huizen, A. M., Menting, S. P., Gyulai, R., Iversen, L., van der Kraaij, G. E., Middelkamp-Hup, M. A., Warren, R. B., Spuls, P. I., Schejtman, A. A., Egeberg, A., Firooz, A., Kumar, A. S., Oakley, A., Foulkes, A., Ramos, A. M. C., Fougerousse, A.-C., Carija, A., Akman-Karakas, A., Horváth, B., … Veldkamp, W. (2022). International eDelphi study to reach consensus on the methotrexate dosing regimen in patients with psoriasis. JAMA Dermatology, 158(5), 561-572. https://doi.org/10.1001/jamadermatol.2022.0434
Warren, R. B., Chalmers, R. J. G., Griffiths, C. E. M., & Menter, A. (2008). Methotrexate for psoriasis in the era of biological therapy. Clinical and Experimental Dermatology, 33(5), 551-554. https://doi.org/10.1111/j.1365-2230.2008.02976.x
Yefta, Winarni, D. R. A., & Wirohadidjojo, Y. W. (2023). Manajemen psoriasis pustulosa. CDKJournal, 50(3), 151-156. https://doi.org/10.1055/f-0004-0002-b000000424
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 JURNAL RISET RUMPUN ILMU KEDOKTERAN
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
