A diagnosis of generalized pustular psoriasis (GPP) can raise questions about symptoms and treatment. Understanding some key facts about GPP can help empower you as you learn how to manage this rare condition.

GPP is a rare but severe form of psoriasis that requires careful treatment and long-term management.

If you or a loved one has GPP, you know the widespread and uncomfortable symptoms this inflammatory condition can cause. You’re also likely to have many questions, including what you can expect in the future.

Read on to find out some key information about your most pressing questions about GPP that you can also further discuss at your next checkup with a healthcare professional.

GPP is considered a lifelong condition. It causes sudden flares of widespread, painful pustules. These pustules are white or yellow bumps filled with noninfectious pus that sit just under the skin. They can join, peel, and leave raw or tender areas behind.

Flares can come on quickly and are often severe enough to require hospitalization. Without prompt treatment, a flare can be life threatening. But the overall outlook is usually better when doctors can find and treat a specific trigger, such as an infection, stress, or stopping certain medications.

GPP is an autoinflammatory condition characterized by flares (a sudden worsening of symptoms) and periods of remission when the skin clears up.

Most people with GPP go through periods where symptoms worsen for a few weeks or even months. During remission, the pustules might partially resolve or clear up completely.

Along with pustules, you might also experience:

  • itchy skin
  • fatigue
  • joint pain
  • muscle aches and weakness
  • flu-like symptoms
  • headache
  • increased pulse
  • decreased blood pressure (can indicate a life threatening flare)

The number of flares you experience can also vary. Some people might have GPP flares several times a year, while others might go into remission for a few years before experiencing another symptom flare. About 50% of flares require hospitalization.

There’s no one-size-fits-all treatment for GPP. Your doctor will tailor a plan based on the severity of your symptoms. They’ll likely prescribe at least one medication.

Many people with GPP need both:

  • long-term medications to prevent future flares and complications
  • short-term medications to ease symptoms and help clear pustules during a flare

Right now, the only FDA-approved medication indicated specifically for GPP is spesolimab (Spevigo). It’s a biologic treatment that works by targeting the inflammation behind GPP. It’s approved for people ages 12 years and older who weigh at least 88 pounds (about 40 kilograms) and comes as an injection or intravenous (IV) infusion.

Other biologics, like infliximab (Remicade), may also be used during a flare to help reduce symptoms quickly. If a biologic doesn’t work for you, your doctor may recommend trying another type of medication.

Along with biologics, your doctor might also suggest the following treatment options:

  • oral retinoids, which can help slow skin cell growth
  • immunosuppressive drugs, such as cyclosporine (Sandimmune) or methotrexate (Trexall), to calm your immune system
  • apremilast (Otezla), another oral medication that may help reduce inflammation and manage flare symptoms
  • oral corticosteroids, such as prednisone (Deltasone), to reduce inflammation
  • topical treatments, including emollients to soothe the skin, topical steroids, and vitamin D analogues to reduce scaling and inflammation

Other targeted treatments that have also shown promise for managing GPP include:

  • IL-17 inhibitors, such as secukinumab (Cosentyx), ixekizumab (Taltz), brodalumab (Siliq), and bimekizumab (Bimzelx)
  • IL-23 inhibitors, including ustekinumab (Stelara), tildrakizumab (Ilumya), risankizumab (Skyrizi), and guselkumab (Tremfya)

Your doctor might consider these options based on the severity of your symptoms, your overall health, and how well you respond to treatment.

It’s crucial to keep in touch with your doctor about your treatment plan. New treatments are continuously being studied for their possible role in managing GPP.

While you might not be able to completely stop the spread of pustular psoriasis, you can take steps to reduce the number of flares you experience and prevent serious complications. This may include:

  • avoiding known triggers like infections, certain medications, and high stress
  • taking your medication exactly as prescribed
  • staying in close contact with your care team

GPP flares cause widespread pustules on the skin, but the underlying inflammation can also spread and lead to more systemic reactions in the body. In severe cases, this inflammation can affect major organs, including the liver, kidneys, and heart, leading to life threatening complications.

If that happens, your doctor may recommend systemic treatments like biologics to help calm the immune system and keep inflammation from spreading beyond your skin.

To help lower your risk of flares, your doctor may suggest:

  • managing stress in a way that works for you
  • taking steps to avoid infections, such as staying up to date on vaccines and practicing good hand hygiene
  • avoiding stopping corticosteroids suddenly (always tapering under medical supervision)
  • checking in with a doctor right away if you notice new or worsening symptoms

Catching and treating a flare early can make a big difference. The sooner you act, the better your chances of keeping symptoms and inflammation from spreading.

In rare cases, GPP can lead to sepsis, a serious, life threatening immune response to infection or severe inflammation.

During a sudden (acute) GPP flare, the body’s inflammatory response can become so intense that it overwhelms your system. This is more likely to happen during your first severe flare or if treatment is delayed.

Sepsis requires emergency care and hospitalization. Without prompt treatment, it can progress to septic shock, which can cause a rapid drop in blood pressure, organ failure, and even death.

Signs of sepsis alongside a GPP flare may include:

  • fever and chills
  • a fast heart rate
  • low blood pressure
  • confusion or disorientation
  • pustules or widespread skin color changes

Sepsis isn’t the only complication linked to GPP. Other possible risks include:

  • gastrointestinal issues, such as nausea or diarrhea
  • delirium or mental confusion
  • hair loss
  • acute kidney or liver injury
  • low levels of calcium in the blood (hypocalcemia)
  • staph infections
  • kidney (renal) failure
  • heart failure
  • acute respiratory distress syndrome (rare)
  • amyloidosis, a rare buildup of amyloid proteins in the organs

While these complications are serious, they’re also uncommon, especially with early diagnosis and treatment. If you ever notice signs of infection or suddenly feel worse during a flare, get medical care right away.

GPP is a rare and serious form of pustular psoriasis that causes widespread pustules and can lead to severe inflammation throughout the body.

While there’s no cure for GPP yet, treatments are available that can help reduce inflammation, ease symptoms, and lower your risk of complications.

It’s crucial that you talk with your doctor. By tracking your symptoms, identifying possible triggers, and adjusting your treatment as needed, you and your doctor can work together to manage flares, avoid hospitalization, and improve your overall quality of life.