“Given the limited research into generalized pustular psoriasis (GPP) and flare episodes, it is important to understand where patients living with this disease go for care and what treatments
they receive,” explains Erin Mangan, PhD. “It is also noteworthy to examine the differences between patients with and without documented flares so we can recognize the gaps in available treatment options and help clinicians better treat patients living with this disease. However, outside of case studies and surveys, little is known about GPP flares.”

For a study published in JAMA Dermatology, the study authors sought to evaluate GPP flares and their treatment. They also examined differences between patients with and without flares documented in EHRs for more than 89 million patients throughout the United States. “From there,
the study team identified key characteristics of GPP and searched for records of each healthcare visit—EDs, observation, inpatient, or urgent care—beginning on or after the date of GPP diagnosis,” Dr. Mangan says. “They aimed to understand how flares are managed in the healthcare setting and identify key differences between patients with and without documented GPP flares.”

Pain Is the Most Documented Symptom During GPP Flares

The study team observed that the most documented symptom of disease during a flare is pain, “underscoring the debilitating nature of the disease,” Dr. Mangan notes. “Patients with GPP flares were also almost three times more likely to have inpatient visits and were more than twice as likely to have ED visits. Furthermore, patients with GPP flares had a higher use of almost all treatment classes. Although GPP is serious and potentially life-threatening, and has a significant disease burden, advanced treatments are rarely used.”

The absence of standard care for GPP was one of the key takeaways from this study, according to Dr. Mangan. “Healthcare professionals are using a wide range of treatments for their patients with GPP, with topical corticosteroids and opioids accounting for the highest use,” Dr. Mangan says. “However, there is little use of advanced treatments (Figure).”

She adds that 24% of patients received no dermatological treatment prior to, during, or immediately after the medical care they sought for a flare, indicating a significant unmet need for these patients.

Strong Need for Better Awareness, Diagnosis & Treatment of GPP 

“GPP flares are devastating for patients and often require ED care or acute care,” she notes. “Therefore, GPP should be considered a top differential diagnosis for a patient presenting with sudden, painful, and widespread pustular eruptions in such settings. Physicians should also keep in mind the potential complications associated with this disease so that urgent attention and care can be provided.”

The researchers would like to see future research focus on further understanding of GPP. “This is a condition that has high comorbidity and a potential for mortality, as well as one with very limited treatment options,” Dr. Mangan says. “There is a strong need within the healthcare community for better awareness, diagnosis, and treatment of patients living with GPP to help them manage this disease and its impact on their QOL.”