Abstract: Generalized pustular psoriasis of pregnancy (GPPP) is a special subtype of generalized pustular psoriasis (GPP), characterized by widespread erythema, pustules, and desquamation during pregnancy, accompanied by high fever, chills, and other symptoms. Severe cases may lead to miscarriage or death. Currently, the safety of medications used to treat GPP in pregnant women remains unclear. We report a case of GPPP successfully treated with spesolimab. The patient, a 31-year-old woman at 15 weeks of gestation, had a 9-year history of GPP with intermittent flare-ups. She had previously received spesolimab one year prior, achieving rapid symptom relief. During pregnancy, her condition recurred, and she was treated again with 900 mg of spesolimab. Within one week, the skin lesions resolved without adverse effects, and she later delivered a healthy baby at full term. After one year of follow-up, the patient remained recurrence-free, and the infant was healthy.

Key words: generalized pustular psoriasis, pregnancy, spesolimab, IL-36 inhibitor