Case Report: Successful treatment of generalized pustular psoriasis with concomitant renal insufficiency using spesolimab: a report of two cases

Generalized pustular psoriasis (GPP) is a rare, severe, and potentially life-threatening neutrophilic dermatosis. Management focuses on rapid control of acute flares and prevention of recurrence. Advances in understanding the central role of interleukin-36 (IL-36) signaling in GPP pathogenesis have shifted the treatment paradigm from traditional systemic immunosuppressants toward targeted biologic therapies. This case report details two patients with GPP and comorbid renal insufficiency who achieved rapid and significant clinical improvement with spesolimab, an IL-36 receptor antagonist. Both patients presented with acute GPP flares and moderate renal impairment. Following a single 900 mg intravenous infusion of spesolimab, skin lesions and systemic symptoms resolved promptly, with disease stability maintained during follow-up. This report provides preliminary evidence supporting the efficacy and safety of spesolimab in this special patient population.