Generalized Pustular Psoriasis Significantly Impacts Patients’ Quality of Life

According to recent research, generalized pustular psoriasis (GPP) has a substantial impact on patient’s quality of life (QoL) and psychological and physical well-being because of chronic symptoms which persist despite treatment.1

Although only representing 1% of all clinical psoriasis cases, GPP is a severe condition characterized by sudden episodes of sterile pustules and widespread rash, occurring with or without systemic inflammation. It often occurs with fever, leukocytosis, and elevated C-reactive protein levels. Given the potential for severe flares, intensive hospital treatment is typically required.2

“The aim of this study was to generate insights into the impact of chronic symptoms and flares, and to understand how patients manage their GPP, including the accessibility and usefulness of patient support materials/programs, and educational resources for GPP,” wrote Lauren Cole, doctoral student at the University of Alabama at Birmingham, and colleagues.1

A qualitative, interview- and survey-based study, this investigation examined patients with GPP from a variety of countries and of several ethnicities. Each included participant had to meet the following criteria:

• >1 month since confirmed GPP diagnosis
• Aged 18-65 years
• ≥1 flare in the past year
• Currently receiving active treatments for GPP (topical or systemic)

Investigators included patients with and without hospitalization for GPP in the past 2 years, ensuring patients with a range of disease experiences were included. Concomitant plaque psoriasis was not considered for inclusion criteria.1

Patients completed a mental well-being tracker and symptom tracker at regular timepoints during the study. The former was completed every 1 month and measured psychological distress using the General Health Questionnaire, which contains 12 items measuring short-term change in mental well-being. The latter was a 15-minute survey completed roughly every 3 months. Patients were asked which symptoms they had experienced, how frequently they occurred, which had the biggest impact on QoL, and which body parts were affected most by the most impactful skin symptoms.1

Investigators included 18 patients with GPP. Of these, 11 were aged 18-40 years and 7 were aged 41-65 years. Comorbidities included plaque psoriasis (28%), psoriatic arthritis (17%), and palmoplantar pustulosis (6%). Most patients (94%) were receiving active GPP treatment, such as biologics, steroids, and retinoids.1

The symptom tracker received roughly 57 total entries and indicated itchiness (82%), dryness (75%), and erythema (70%) as the most common symptoms. Fatigue (65%), peeling (60%), and pustule presence (58%) were also frequently reported. Daily burden was largely caused by itchiness (40%), fatigue (27%), and pustules (21%). The arms, palms, and scalp were the most frequently affected.1

Investigators also found that 50% of patients reported a moderate to extreme impact of skin symptoms on QoL. A single patient reported an extremely large effect (average DLQI score: 22), 3 reported a very large effect (average DLQI score: 12.8), 5 reported a moderate effect (average DLQI score: 7.8), and 7 reported a small effect (average DLQI score: 3.1). The mean score was 6.1, indicating moderate impact.1

Additionally, 1 in 3 patients needed to alter clothing choice due to sensory discomfort, and half reported struggles with travel and daily tasks due to chronic symptoms. Another 1 in 3 reported severe work-related issues.1

Psychological stress levels were highest among those experiencing flares, followed by those with chronic symptoms. Financial concerns, relationship or family problems, and non-GPP illnesses were cited as main contributors to distress. Patients experiencing flares noted a significant burden from GPP symptoms.1

Ultimately, investigators noted these results as indicative of consistent and recurring issues among patients with GPP.

“These findings highlight the importance of developing new treatments that can address both the physical and psychological aspects of GPP to improve QoL,” Cole and colleagues wrote. “Targeted treatments that can provide continuous disease control are essential for enhancing QoL and addressing the challenges faced by individuals living with GPP.”1

References

1. Kole, L.C.S., Tada, Y., Gerdes, S. et al. A Global Assessment of Patient Experience and Quality of Life in Generalized Pustular Psoriasis: Results from Interviews and Online Surveys. Dermatol Ther (Heidelb) (2025). https://doi.org/10.1007/s13555-025-01483-2

2. Marrakchi S, Puig L. Pathophysiology of Generalized Pustular Psoriasis. Am J Clin Dermatol. 2022;23(Suppl 1):13-19. doi:10.1007/s40257-021-00655-y