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All Journal Indonesian Journal of Biomedicine and Clinical Sciences
Rizka Fauziyah
Department of Dermatology and Venereology, Faculty of Medicine, Public Health, and Nursing, Gadjah Mada University – Sardjito Central General Hospital, Yogyakarta, Indonesia
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience

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Rapid improvement of guttate psoriasis following inadequate response to prior systemic therapy using 311 nm narrowband ultraviolet B (NB-UVB) phototherapy Rizka Fauziyah; Hardyanto Soebono; Arief Budiyanto
Indonesian Journal of Biomedicine and Clinical Sciences Vol 58 No 2 (2026)
Publisher : Published by Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/inajbcs.v58i2.27922

Abstract

Guttate psoriasis (GP) is a variant of psoriasis commonly affecting children and young adults, often triggered by infection. Although most cases respond to topical therapy, some patients show inadequate response to prior treatment. Narrowband ultraviolet B (NB-UVB) phototherapy is considered a safe and effective therapeutic option in such cases. A 12-year-old boy presented with multiple erythematous papules with fine scales distributed over the trunk and extremities. Laboratory findings revealed elevated antistreptolysin-O titers. Based on the clinical and histopathology features, the patient was diagnosed with GP. The patient had previously received low-dose methotrexate therapy (2.5 mg/week) for approximately six months with inadequate clinical response. NB-UVB phototherapy was initiated three times weekly with gradual dose escalation. Marked clinical improvement was observed after 18 sessions, achieving PASI90. NB-UVB phototherapy exerts therapeutic effects through immunomodulation and reduction of keratinocyte proliferation. The rapid response observed in this case may be related to lesion characteristics and the appropriate selection of therapy following subtherapeutic methotrexate dosing. Based on this case, it can be concluded that NB-UVB phototherapy may be an effective and well-tolerated treatment option for GP with inadequate response to prior therapy, particularly in pediatric patients.
Methotrexate therapy in generalized pustular psoriasis: a report of two cases: Clinical Characteristics and Treatment Outcomes of Methotrexate Therapy Rizka Fauziyah; Hardyanto Soebono; Sri Awalia Febriana
Indonesian Journal of Biomedicine and Clinical Sciences Vol 58 No 3 (2026)
Publisher : Published by Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/inajbcs.v58i3.29384

Abstract

Generalized pustular psoriasis (GPP) is a rare, severe inflammatory skin disease associated with systemic complications and significant morbidity. Management remains challenging because of the lack of standardized treatment protocols. Methotrexate is a conventional systemic therapy for psoriasis; however, evidence regarding structured pulse-dose regimens for GPP is limited. We report two adult patients with generalized pustular psoriasis managed at the Dermatology and Venereology Clinic of Sardjito General Hospital, Yogyakarta. Diagnosis was established through clinical evaluation, laboratory examination, and histopathological assessment. Both patients received weekly pulse-dose methotrexate injections (50 mg) for six cycles, with serial clinical monitoring using the Generalized Pustular Psoriasis Area and Severity Index (GPPASI). Both patients demonstrated marked clinical improvement following treatment. GPPASI scores decreased significantly after six cycles of therapy, accompanied by an improvement in laboratory inflammatory parameters, without significant hepatic or renal impairment. This report highlights the use of structured pulse-dose methotrexate therapy with serial GPPASI monitoring in adult patients with generalized pustular psoriasis managed in a resource-limited setting. Significant clinical improvement was observed after six cycles of therapy. Further studies are required to evaluate its long-term efficacy and safety.
Co-Authors Arief Budiyanto Hardyanto Soebono Sri Awalia Febriana