• Kazumitsu Sugiura, Akemi Takemoto, Michiya Yamaguchi, Hidetoshi Takahashi, Yukiko Shoda, Teruyuki Mitsuma, Kenshiro Tsuda, Emi Nishida, Yaei Togawa, Kimiko Nakajima, Akihiro Sakakibara, Shigeo Kawachi, Makoto Shimizu, Yasutomo Ito, Takuya Takeichi, Michihiro Kono, Yasushi Ogawa, Yoshinao Muro, Akemi Ishida-Yamamoto, Shigetoshi Sano, Hiroyuki Matsue, Akimichi Morita, Hitoshi Mizutani, Hajime Iizuka, Masahiko Muto, and Masashi Akiyama.
• Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: kazusugi@med.nagoya-u.ac.jp.
• J. Invest. Dermatol. 2013 Nov 1; 133 (11): 2514-2521.

AbstractGeneralized pustular psoriasis (GPP) is a rare inflammatory skin disease that can be life-threatening. Recently, it has been reported that familial GPP is caused by homozygous or compound heterozygous mutations of IL36RN. However, the majority of GPP cases are sporadic and it is controversial whether IL36RN mutations are a causative/predisposing factor for sporadic GPP. We searched for IL36RN mutations in two groups of GPP patients in the Japanese population in this study: GPP without psoriasis vulgaris (PV), and GPP with PV. Eleven cases of GPP without PV (GPP alone) and 20 cases of GPP accompanied by PV (GPP with PV) were analyzed. Surprisingly, 9 out of 11 cases of GPP alone had homozygous or compound heterozygous mutations in IL36RN. In contrast, only 2 of 20 cases of GPP with PV had compound heterozygous mutations in IL36RN. The two cases of GPP with PV who had compound heterozygous mutations in IL36RN are siblings, and both cases had PV-susceptible HLA-A*0206. We determined that GPP alone is a distinct subtype of GPP and is etiologically distinguished from GPP with PV, and that the majority of GPP alone is caused by deficiency of the interleukin-36 receptor antagonist due to IL36RN mutations.

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