What Is Generalized Pustular Psoriasis (GPP)? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Unlike localized pustular psoriasis, which occurs on one area of the body, a GPP flare involves a widespread rash with pustules, or small bumps containing pus (a white or yellow fluid filled with dead white blood cells).

“In psoriasis, there are microscopic little collections of pus cells,” says Steven Feldman, MD, PhD, a dermatologist who specializes in psoriasis at Atrium Health Wake Forest Baptist in Winston-Salem, North Carolina. “But in generalized pustular psoriasis, which is a very abrupt and severe flare, people get the psoriasis all over their body, and those little microscopic pus cells get so large that they are visible with the naked eye.”

In severe cases, GPP can become life-threatening if left untreated.

• Acute GPP
• Annular pustular psoriasis
• Localized or chronic acral GPP
• Pustular psoriasis of pregnancy
• Infantile and juvenile pustular psoriasis
• Mixed GPP

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Acute GPP

Annular Pustular Psoriasis

Localized or Chronic Acral GPP

Pustular Psoriasis of Pregnancy

Infantile and Juvenile Pustular Psoriasis

Mixed GPP

• Fever
• Chills and shivers
• Intense itching
• Rapid pulse
• Fatigue
• Headache
• Nausea
• Muscle weakness
• Joint pain

“People have psoriasis in part due to their genetics, and so they’ll be predisposed to having psoriasis, but then they’ll get an infection or be exposed to some drug that activates their immune system and causes the psoriasis to severely flare up,” Dr. Feldman says.

• Illness or infection
• Use of certain medications These may include withdrawal from corticosteroid treatment, as well as antibiotics and antifungals, Feldman says.
• Pregnancy
• Psychological stress
• Hypocalcemia This is a condition that results from an abnormally low level of calcium in your blood

To diagnose GPP, a doctor will perform a physical exam, ask about your medical history, review symptoms, examine a sample of skin tissue (biopsy), and possibly test pustules to rule out other potential causes. Psoriasis or a history of psoriasis could indicate GPP for some but not all people.

Doctors unfamiliar with GPP may misdiagnose symptoms as an infection or simple psoriasis, especially in patients experiencing a flare for the first time.

When a GPP flare occurs, it’s important to get it under control as soon as possible to avoid complications, Feldman says.

Spesolimab (Spevigo) for GPP

Delivered by injection, the drug blocks the activation of the interleukin-36 receptor (IL-36R), a key part of a signaling pathway within the immune system involved in GPP.

Psoriasis Medications

• Oral retinoid Oral retinoids are derived from vitamin A. They are usually reserved for severe psoriasis, and research about their efficacy is limited.

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• Biologics Biologics target the part of the immune system that is overactive because of psoriasis, decreasing inflammation and bumps quickly. Medications in this class include:
• infliximab (Remicade)
• adalimumab (Humira)
• etanercept (Enbrel)
• apremilast (Otezla) This drug works by controlling inflammation in the immune cells.

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• methotrexate (Jylamvo, Otrexup, Rasuvo) This strong medication suppresses the overactive immune system.

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• cyclosporine (Sandimmune, Neoral) This fast-acting medication also works by suppressing the immune system, Feldman says.

In addition to these systemic treatments that focus on the immune system, physicians also need to address specific skin issues.

“Often, the skin of someone with GPP is treated in the same way that a person with severe burns would be treated — with special kinds of bandages, special emollients, and antibiotics,” Feldman says.

GPP triggers can vary from person to person; trying to avoid or limit exposure to known triggers can help reduce the risk of a flare.

“If [the trigger is] a medication, then you want to avoid that medication,” Feldman says.

If infections are a trigger, that’s more difficult. You can’t always avoid getting them. But if you do, your doctor should monitor you closely, Feldman says.

You may want to talk to your doctor or healthcare provider about vaccinations as a means to help prevent infections, such as the flu, COVID-19, and others.

• Losing weight
• Avoiding alcohol and smoking, Feldman says
• Keeping your skin moist
• Exercising
• Managing your stress

• Sepsis, a condition in which the body’s response to infection damages its own tissue
• Acute respiratory distress syndrome, in which fluid collects in the lungs’ air sacs, depriving organs of oxygen
• Cardiac failure
• Acute renal failure
• Heart failure

Feldman says, however, that advances in medications may be making these complications less common.

GPP can affect people of any skin color, Feldman says.

• United Kingdom
• Germany
• Tunisia
• Malaysia
• China
• Japan

Plaques are raised, inflamed, and scaly patches of skin that can be painful and itchy. On white skin, they usually look red with a silvery white buildup of scales. On darker skin tones, the plaques may appear thicker and more of a purple, gray, or dark brown color.

Plaques can appear anywhere on the body but they occur most often on the scalp, knees, elbows, and torso.

Mental health can play an important role in managing flares, treatment, and stress.

You may find support from friends and family, but you may also benefit from finding other people near you or online who also live with psoriasis.

National Psoriasis Foundation
The National Psoriasis Foundation offers help with finding other people living with psoriasis, as well as ways to get involved in its community and to seek help for children and teens.

Inspire Community Forum
Inspire’s network of online support groups includes a forum designed for people living with psoriasis.

Psoriasis Association
This organization, based in the United Kingdom, offers online forums, a private Facebook group, and ways to share your personal story.

Your healthcare provider may have additional resources for you to explore, as well.

• Generalized pustular psoriasis (GPP) is rare but can be lethal, with a 5 to 10 percent fatality rate.
• The condition may be more common in women than men, and it can affect people of any age.
• Treatments can help prevent complications and flares.
• During a flare, you should seek medical attention if you develop other symptoms, such as fever.