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All Journal E-Jurnal Medika Udayana Jurnal Pendidikan Kewarganegaraan Undiksha JURTEKSI Jurdimas (Jurnal Pengabdian Kepada Masyarakat) Royal Majalah Patologi Indonesia Bioscientia Medicina : Journal of Biomedicine and Translational Research Journal I La Galigo : Public Administration Journal Jutsi: Jurnal Teknologi dan Sistem Informasi Bioscientia Medicina : Journal of Biomedicine and Translational Research J-Com (Journal of Computer) Bali Dermatology Venereology and Aesthetic Journal Indonesian Journal of Biomedicine and Clinical Sciences International Journal of Law, Crime and Justice
Herman Saputra
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Biochemistry, Genetics & Molecular Biology Computer Science & IT Education Health Professions Immunology & microbiology Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Neuroscience Public Health Social Sciences

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The Oral-Skin Axis in Autoinflammation: A Case Report of Severe Refractory Generalized Pustular Psoriasis (GPP) Resolved by Comprehensive Periodontal Intervention Ni Putu Wina Widyastuti; Prima Sanjiwani Saraswati Sudarsa; Herman Saputra; Handelia Phinari; Luh Putu Venny Cempaka Sari; Kevin Jonathan Djuanda; Mario Korwa
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i2.1499

Abstract

Background: Generalized pustular psoriasis (GPP) is a severe, IL-36-driven autoinflammatory dermatosis, distinct from psoriasis vulgaris. Chronic periodontitis (CP) is a dysbiotic inflammatory disease sharing pathogenic pathways (IL-1, IL-17). An "oral-skin axis" has been hypothesized, but definitive clinical evidence of CP driving a GPP flare is scarce. Case presentation: We present a 37-year-old male with a history of plaque psoriasis who developed a severe, refractory GPP flare (GPPASI 35.8) with high-grade fever (38.9°C), profound neutrophilic leukocytosis (22.5 x 10³/µL), and markedly elevated CRP (150 mg/L). The flare was resistant to maintenance methotrexate. Workup revealed severe CP with multiple periapical abscesses, culture from which grew Porphyromonas gingivalis and Fusobacterium nucleatum. The patient underwent a comprehensive dental intervention, including emergency extractions and full-mouth debridement, with concurrent peri-operative Amoxicillin-Clavulanate therapy. This combined intervention led to a rapid resolution of fever, neutrophilia, and cutaneous pustulation within 72 hours, without any escalation of systemic immunomodulators. He achieved complete remission (GPPASI 1.0) at 3-month follow-up. Conclusion: This case provides a strong temporal association supporting the oral-skin axis, highlighting severe periodontitis as a potent trigger and amplifier for GPP. The rapid resolution following a combined surgical and antibiotic intervention suggests that targeting the oral inflammatory and microbial reservoir is a critical, actionable strategy. We strongly recommend consideration of a comprehensive dental/oral screening in patients with refractory GPP.
Co-Authors Adelia Suryani Adi Prijuna Lubis Agus Maulizar Anak Agung Ayu Ngurah Susraini Andrew Wicaksono Arif Ferdian Bagus Ardiansyah Putra Darmansyah Darmansyah Darmaputra, I Gusti Nyoman Dewi Gotama Djuanda, Kevin Jonathan Fittri Royani Handelia Phinari Herlina Eka Shinta Hommy Dorthy Ellyany Sinaga I Gede Indradika Pratama Putra I Gusti Alit Artha I Gusti Ayu Sri Mahendra Dewi I Gusti Bagus Mulia Agung Pradnyaandara I Gusti Ngurah Bagus Rai Mulya Hartawan I Gusti Ngurah Made Cesar Vajrashrava Sunantara I Kadek Adi Purnama Sandhi I Kadek Yana Parastuta I Nyoman Sasputra I Wayan Juli Sumadi I. G. A. A. Elis Indira Ifvan Limalasa Mayendra Indra Gunawan John Nolan kadek pramesti dewi Ketut Kwartantaya Winaya Kevin Jonathan Djuanda Komang Chandra Surya Dika Lisa Alverina Luh Dewi Rahayu, Luh Made Mas Rusyati Luh Putu Iin Indrayani Maker Luh Putu Venny Cempaka Sari Made Sanitca Indah Mario Korwa Marzuki Marzuki Mhd Ihsan Muhammad Hatta Nandya Dwizella Ni Ketut Ari Widhiasih Ni Luh Putu Ratih Vibriyanti Karna Ni Made Dwi Puspawati Ni Made Mahastuti Ni Putu Ekawati Ni Putu Sriwidyani Ni Putu Sriwidyani Ni Putu Wina Widyastuti Nur Laila Sari Nyoman Suryawati Oni Dewi Lestari Prima Saraswati Sanjiwani Sudarsa Putu Dony Astika Wiguna Putu Evi Tania Herry Putri Putu Febry Krisna Pertiwi Putu Setiani Rahayu, Elly Ruri Ashari Dalimunthe Suharmono Hadi Syamjaya Syamjaya USWATUN HASANAH Waode Aminah Andella