Elizabeth M. Staley MD, PhD, Huy P. Pham MD, MPH

Transfusion Medicine and Hemostasis (Fourth Edition), Elsevier, 2025, chapter 87, Pages 399-401, ISBN 9780323960144, https://doi.org/10.1016/B978-0-323-96014-4.00049-5.

Leukocytaphersis (or leukapheresis) is a therapeutic procedure in which white blood cells (WBCs) are selectively removed from the patient’s circulation. The procedure is performed for the treatment of hyperleukocytosis most commonly in the setting of leukemia. Adsorptive cytapheresis utilizes apheresis in association with a medical device to selectively extract leukocyte subsets (activated monocytes and granulocytes) from the patient’s circulation. Adsorptive cytapheresis has been utilized for the treatment of multiple inflammatory conditions including inflammatory bowel disease, systemic lupus erythematosus, psoriasis, Behçet’s disease, and rheumatoid arthritis.

Mary Grace Hash¹, Guang Orestes², Camile Delva³, Bailey Patrick⁴, Donna Pham⁵, Olivia Biddle⁶, Teonna Sharpe⁷, Kaitlyn Miner⁸, Kelly Frasier^9,*

Dermis. 5(1):28.

Psoriasis treatment demonstrates significant racial disparities, with Black patients and other individuals with skin of color experiencing higher disease severity yet receiving less access to advanced therapies compared to White patients. This review examines existing literature on differences in prescription patterns, treatment modalities, and clinical outcomes for psoriasis in White versus Black populations. Focus is placed on biologics, systemic non-biologic therapies, phototherapy, and topical treatments, highlighting inequities in treatment access, clinician decision-making, and infrastructure availability. Black patients are consistently underprescribed advanced therapies, such as IL-17 and IL-23 inhibitors, despite evidence supporting their efficacy in severe plaque-dominant phenotypes. Instead, systemic corticosteroids and methotrexate are disproportionately prescribed, even though they are associated with suboptimal outcomes and higher side-effect profiles. Phototherapy, while effective for darker skin types, is less frequently recommended due to barriers including access and clinician unfamiliarity with tailoring treatment for skin of color. Emerging data suggests that the specialty of the prescribing clinician plays a role in these disparities, with non-dermatologists being less likely to initiate biologic therapies and more likely to prescribe older systemic treatments. Additionally, structural barriers, including limited access to dermatologists and phototherapy centers equipped for darker skin tones, exacerbate inequities. This review identifies key gaps in understanding, including the impact of implicit bias on treatment decisions, differences in adherence and patient-reported outcomes by race, and the role of systemic factors such as insurance coverage and geographic access to care. Strategies to address these disparities include expanding education for non-dermatologist providers, improving infrastructure for phototherapy, and incorporating culturally sensitive approaches into patient education and clinician training.

Ludovica Franceschin ¹, Alessia Guidotti ¹, Roberto Mazzetto ¹, Jacopo Tartaglia ¹, Christian Ciolfi ¹, Mauro Alaibac ¹, Alvise Sernicola ¹

Biomolecules. 2024 Nov 27;14(12):1515. doi: 10.3390/biom14121515.

Neutrophil-mediated inflammation is a key feature of immune-mediated chronic skin disorders, but the mechanistic understanding of neutrophil involvement in these conditions remains incomplete. Dapsone, colchicine, and tetracyclines are established drugs within the dermatologist’s therapeutic armamentarium that are credited with potent anti-neutrophilic effects. Anti-neutrophilic drugs have established themselves as versatile agents in the treatment of a wide range of dermatological conditions. Some of these agents are approved for the management of specific dermatologic conditions, but most of their current uses are off-label and only supported by isolated reports or case series. Their anti-inflammatory and immunomodulatory properties make them particularly valuable in managing auto-immune bullous diseases, neutrophilic dermatoses, eosinophilic dermatoses, interface dermatitis, and granulomatous diseases that are the focus of this review. By inhibiting inflammatory pathways, reducing cytokine production, and modulating immune responses, they contribute significantly to the treatment and management of these complex skin conditions. Their use continues to evolve as our understanding of these diseases deepens, and they remain a cornerstone of dermatological therapy.

GMA is a promising alternative in patients who have failed conventional therapies for generalized pustular psoriasis, pyoderma gangrenosum, Behçet’s disease, and hidradenitis suppurativa. The strengths of GMA lie in its favorable tolerability and peculiar mode of action that is able to deplete inflammation without causing immunodeficiency.

Walter Jauregui ¹, Yozahandy A Abarca ², Yasmin Ahmadi ³, Vaishnavi B Menon ⁴, Daniela A Zumárraga ⁵, Maria Camila Rojas Gomez ⁶, Aleeza Basri ⁷, Rohitha S Madala ⁸, Peter Girgis ⁹, Zahra Nazir ¹⁰

Cureus. 2024 Sep 3;16(9):e68569. doi: 10.7759/cureus.68569. eCollection 2024 Sep.

Psoriasis (PS) and inflammatory bowel disease (IBD) are immune-mediated chronic conditions that share pathophysiological processes, including immune system dysfunction, microbiome dysbiosis, and inflammatory pathways. These pathways result in increased turnover of epithelial cells and compromised barrier function. The assessment of the literature suggests that immunopathogenic mechanisms, such as tumor necrosis factor (TNF)-α signaling and IL-23/IL-17 axis dysregulation, are shared by PS and IBD. Clinical characteristics and diagnostic approaches overlap significantly, and advances in biomarker identification benefit both conditions. Current treatments, namely biologics that target TNF-α, IL-17, and IL-23, show promising results in decreasing inflammation and controlling symptoms. Precision medicine approaches are prioritized in prospective therapeutic procedures to tailor pharmaceuticals based on specific biomarkers, perhaps improving outcomes and minimizing side effects. This study thoroughly examines and evaluates the body of research on PS and IBD. Several papers were examined to compile data on clinical features, diagnosis, therapies, pathophysiology, epidemiology, and potential future therapeutic developments. The selection of articles was based on three methodological qualities: relevance and addition to the knowledge of IBD and PS. The retrieved data were combined to provide a coherent summary of the state of the knowledge and to spot new trends. The overview of the latest studies demonstrates that both PS and IBD share pathophysiological foundations and therapeutic approaches. With a spotlight on particular biomarkers, advances in precision medicine provide a promising path toward enhancing therapeutic effectiveness and minimizing side effects.

in CD Moderate to severe Oral corticosteroids. Consider enteral nutritional therapy. TNF inhibitors are recommended to be considered for steroid-dependent or refractory patients. If pharmacotherapy or nutrition therapy is ineffective or unable to adapt, the combination with granulocyte monocyte apheresis (GMA) can be considered.

Lluís Puig ¹, Hideki Fujita ², Diamant Thaçi ³, Min Zheng ⁴, Ana Cristina Hernandez Daly ⁵, Craig Leonardi ⁶, Mark G Lebwohl ⁷, Jonathan Barker ⁸

Dermatol Ther (Heidelb). 2024 Sep;14(9):2331-2378. doi: 10.1007/s13555-024-01230-z. Epub 2024 Aug 1.

Generalized pustular psoriasis (GPP) is a rare, chronic and potentially life-threatening autoinflammatory skin disease characterized by widespread eruption of sterile pustules, with or without systemic inflammation. GPP can significantly reduce patients’ quality of life (QoL). Several therapeutic approaches have been described in the literature, but there is no consensus on optimal treatment. In this review, we summarize published literature on efficacy, safety and QoL outcomes associated with current treatment of GPP with both approved and non-approved products. Embase and MEDLINE databases were searched (1980-September 2023). A search protocol was designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered on the PROSPERO database (CRD42021215437). Details on publication, population, intervention, efficacy, safety and QoL were captured and checked by independent reviewers. In total, 118 publications were included, with only 19% of publications reporting on the results of clinical trials. Treatment modalities reported for GPP included non-biologic systemic therapies such as retinoids, cyclosporine and methotrexate, topical agents, biologics and small molecules, among others. Results were highly heterogeneous and methodological quality was very low, with only the interleukin-36R inhibitor spesolimab reporting results from placebo-controlled randomized trials; based on this, spesolimab is now approved for GPP treatment in regions including the USA, Japan, China, the EU and several other countries. Some other biologics are approved exclusively in Japan and Taiwan for the treatment of GPP based on open-label studies with small patient numbers in lieu of double-blind studies. Non-standardization of clinical outcomes across studies remains a major hurdle in reaching a consensus on optimal treatment. However, recently trials have been conducted using well-defined, disease-specific endpoints to evaluate GPP-targeted treatments, which will hopefully advance patient care. In conclusion, this review highlights the need for prospective randomized studies with GPP-specific endpoints to determine the optimal treatment strategy.

GMA was approved for the treatment of GPP in Japan in 2012 

Rolf Bambauer¹*, Ralf Schiel², Octavio J Salgado³and Richard Straube (2024) Adv Res Dermatol Cosmetics 3: 1017

Severe and/or refractory dermatological diseases with immunologic origin to conventional therapy have a bad
prognosis. Autoimmune blistering diseases have a high morbidity and mortality. Therapeutic apheresis is an essential supportive treatment for severe and refractory dermatological diseases with an immunologic origin, particularly autoimmune blistering diseases. This approach has been shown to significantly improve the prognosis of these diseases.
Therapeutic apheresis, combined with immunosuppressive therapy and/or human monoclonal antibodies, has treated successfully autoimmune blistering skin disorders. These diseases are caused by the immune system’s targeting of structural proteins in the skin and/or mucous membranes. Improved diagnostic methods have allowed to determine that the incidence and prevalence of these disorders have doubled in the last 15 years to 25 new cases per million people per year owing to an aging population. Over the last 45 years, therapeutic apheresis, in combination with immunosuppression and/or human monoclonal antibodies, has significantly increased survival rates. Therapeutic apheresis using hollow fiber modules is safe and highly effective in eliminating autoantibodies and other toxins from the bloodstream, leading to rapid clinical improvement in dermatological conditions. The guidelines of the for American Application Committee of the American Society for Apheresis are cited dermatologic disorders, which could be treated with therapeutic apheresis

Arun K. Mankan, Paulina Czajka-Francuz, Maria Prendes, Sriram Ramanan, Marcin Koziej, Laura Vidal, Kamal S. Saini Front. Immunol., 2023, 14, doi.org=10.3389/fimmu.2023.1208137

As the first responders, neutrophils lead the innate immune response to infectious pathogens and inflammation inducing agents. The well-established pathogen neutralizing strategies employed by neutrophils are phagocytosis, the action of microbicide granules, the production of ROS, and the secretion of neutrophil extracellular traps (NETs). Only recently, the ability of neutrophils to sense and respond to pathogen-associated molecular patterns is being appreciated. This review brings together the current information about the intracellular recognition of DNA by neutrophils and proposes models of signal amplification in immune response. Finally, the clinical relevance of DNA sensing by neutrophils in infectious and non-infectious diseases including malignancy are also discussed.

Matteo Megna 1, Elisa Camela 2, Angelo Ruggiero 1, Teresa Battista 1, Fabrizio Martora 1, Sara Cacciapuoti 1, Luca Potestio. Clin Cosmet Investig Dermatol. 2023 Jun 28:16:1677-1690. doi=10.2147/CCID.S407812

Generalized pustular psoriasis (GPP) is a severe and rare form of psoriasis, being a potentially life-threatening condition, characterized by recurring episodes or flares of widespread cutaneous erythema with macroscopic sterile pustules. An irregular innate immune response is linked to GPP, which is considered an auto-inflammatory disorder, while innate and adaptive immunopathogenic responses are involved in psoriasis pathogenesis. In consequence, different cytokine cascades have been suggested to be mainly involved in the pathogenesis of each different psoriasis form, with the interleukin (IL)23/IL17 axis implied in plaque psoriasis, and the IL36 pathway in the GPP. As regards GPP treatment, conventional systemic drugs available for plaque psoriasis are usually used as the first-line treatment option. However, contraindications and adverse events often limit the use of these therapies. In this scenario, biologic drugs may represent a promising treatment option. To date, even if 12 different biologics have been approved for plaque psoriasis, none of these is approved for GPP where they are employed off-label. Recently, spesolimab, an anti-IL36 receptor monoclonal antibody, has been recently approved for GPP. The purpose of this article is to assess the current literature about the use of biological therapies for the treatment of GPP to establish the basis for a shared GPP management algorithm.

Laura Gnesotto ¹, Guido Mioso ¹, Mauro Alaibac ¹

Exp Ther Med 2022 Jun 24;24(2):536. doi: 10.3892/etm.2022.11463. eCollection 2022 Aug. DOI: 10.3892/etm.2022.11463

Adsorptive granulocyte and monocyte apheresis (GMA) is an extracorporeal treatment that selectively removes activated myeloid lineage leukocytes from peripheral blood. This technique consists of a column with cellulose acetate beads as absorptive leukocytapheresis carriers, and was initially used to treat ulcerative colitis. A literature search was conducted to extract recently published studies about the clinical efficacy of GMA in patients with different skin disorders, reporting information on demographics, clinical symptoms, treatment and clinical course. Dermatological diseases, in which GMA has been performed, include generalized pustular psoriasis, pyoderma gangrenosum, palmoplantar pustular psoriasis, Behcet’s disease, Sweet’s syndrome, adult-onset Still’s disease, impetigo herpetiformis, reactive arthritis, acne and hidradenitis suppurativa syndrome, cutaneous allergic vasculitis and systemic lupus erythematosus. In most patients, GMA was started after the failure of conventional therapeutic options and it was helpful in the majority of cases. Based on the information summarized, GMA could be considered a valid non-pharmacological treatment option for patients with several dermatological conditions, which are difficult to treat with other pharmacological preparations.

 PASH syndrome; cutaneous allergic vasculitis; granulocyte and monocyte apheresis; neutrophilic dermatoses; reactive arthritis; systemic lupus erythematosus.

https://pubmed.ncbi.nlm.nih.gov/35837066/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9257973/

Asumi Fujii, Yuki Hattori, Miho Kawamura, Yoko Mizutani, En Shu, Mariko Seishima

poster at ISFA 2019 pag 141-142

A 31-year-old woman with the IL36RN gene mutation developed psoriasis at 3 years old. As she had pustular psoriasis at 16 years old, she was treated with cyclosporine (Cys), resulting in remission at 20 years old. Afterwards, she had been maintained by topical treatment for long years.During the first pregnancy at the age of 29, she developed pustular psoriasis at 29 weeks
of gestation. She received one course of granulocyte / monocyte adsorption apheresis (GMA) with Cys and prednisolone (PSL), and gave birth to a girl at 33 weeks of gestation. The baby was a low birth weight child, but is healthy and has no problems in growth and development until now. However, the patient did not sufficiently improve symptoms after delivery. We thus started the treatment with infliximab (IFX) BS at 2 months postpartum. During the second pregnancy at the age of 30, we continued the IFX-BS administration. She had erythema and pustules rapidly enlarged from 23 weeks of pregnancy. Oral administration of PSL and GMA were started. However, we switched the therapy to intensive GMA (twice in a week), because the effect was insufficient. Initially, administration of IFX-BS was scheduled to end at 30 weeks of gestation, but due to unstable symptoms, we considered it was necessary to use another biologics even after 30 weeks of gestation. We switched to non-placental certolizumab pegol (CTZ) from 26 weeks of gestation and continued the administration until delivery, and she gave birth to a girl at 35 weeks of gestation. Although the baby was a low birth weight child, there was no physical abnormality and the baby was discharged after gaining weight. After delivery, administration of CTZ was discontinued and the PSL dose was gradually reduced. However,reintroduction of biologics is under consideration, because erythema and pustules still remain.

http://www.atalacia.com/isfa/data/abstract.pdf