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All Journal Indonesian Journal of Biomedicine and Clinical Sciences
Sri Awalia Febriana
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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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 Hardyanto Soebono Rizka Fauziyah