If you have generalized pustular psoriasis (GPP), it’s important to talk to your doctor about what to do when you have a flare-up. GPP can get serious fast and may lead to life-threatening complications.
Your doctor will create a plan to treat your symptoms, prevent problems, and prevent GPP from worsening.
Why Is GPP Treatment Urgent?
If a flare isn’t treated quickly, you may have complications like sepsis or organ failure, which can lead to death.
Complications of GPP include:
- A sudden drop in blood pressure
- Heart failure
- Liver failure
- Kidney failure
- Respiratory failure
- Sepsis
How Do You Know If a Flare Is Serious?
A GPP flare may start off with inflammation and eruptions of pustules, or pus-filled bumps, on your skin. It may come on suddenly, which is common with GPP.
You may have other symptoms too, such as:
- Chills
- Fatigue
- Fever
- Headache
- Joint pain
- Muscle weakness
- Nausea
- Rapid pulse
- Severe itching
These symptoms are a sign that it’s time to call your doctor.
Your doctor may send you to the hospital to get your flare under control so it doesn’t lead to life-threatening complications.
About half of people with GPP need to go to the hospital for treatment.
What May Trigger a GPP Flare?
Your doctor may talk to you about triggers. If you know your triggers, you can avoid them or manage them so you’re less likely to get a flare.
Common GPP triggers include:
- Certain medications like methotrexate (Otrexup (PF), Rasuvo, Xatmep), ustekinumab (Stelara), and TNF-alpha blockers
- Corticosteroid treatment withdrawal
- Infections
- Injuries
- Low calcium levels
- Menstruation
- Pregnancy
- Skin irritants
- Smoking
- Stress
- Sunlight
- Vaccines
Your doctor can help you learn how to avoid specific triggers and reduce the impact of others. For example, if you smoke, your doctor will recommend quitting. They may also help you with a plan to quit. They may suggest how to avoid too much sunlight or what to do if you get injured.
How Do You Treat GPP?
Your doctor may create a two-part plan to treat your GPP. First, they’ll decide how to treat your flares quickly. Next, they’ll decide how to manage GPP over time, which may cut back on how often you have a flare.
Short-term goals. The immediate goals of GPP treatment are to improve your symptoms and prevent complications. Your doctor will give you fast-acting medication to slow inflammation, clear up pus-filled bumps, and relieve symptoms like pain, itching, fever, and chills.
Long-term goals. Your doctor will also decide how to manage your GPP over time. The goals may include preventing flares, stopping GPP from worsening, and finding ways to spot a flare quickly before it leads to complications.
Your doctor will also set up a plan to manage other medical conditions you may have, like high blood pressure, diabetes, or heart disease.
What Treatments Are Available for GPP?
The only FDA-approved medication to treat GPP is spesolimab (Spevigo). This drug targets your immune system to treat GPP flares quickly. It’s considered safe and effective.
If you have a GPP flare, your doctor may give you an IV injection of spesolimab. If your symptoms don’t improve within a week, they may give you a second dose.
You may have regular doses of spesolimab even if you’re not having a flare. You may get them every four weeks or so.
Your doctor may recommend other medications to help with symptoms, such as:
- Acitretin (Soriatane)
- Apremilast (Otezla)
- Biologics like infliximab (Remicade), ixekizumab (Taltz), and secukinumab (Cosentyx)
- Cyclosporine (Gengraf, Neoral, Sandimmune)
- Methotrexate
- Oral retinoids
You may take more than one medication at a time. Your doctor may start with one medication, and then switch to another. Some medicines may have side effects.
Talk to your doctor about what may be best for you and what to do if your treatment isn’t working.
Do GPP Medications Have Side Effects?
Certain medications that help with GPP flares have side effects.
For example, taking cyclosporine long-term is linked to side effects like high blood pressure, kidney damage, and a higher risk of infections and cancer. To lower your risk, your doctor may use it to control your symptoms during a serious flare, then switch to a different medication when it’s under control.
Another example is acitretin. While this medication can quickly treat a flare, it’s known to have side effects like hair loss and chronic lip inflammation.
Infliximab often helps severe GPP and can be used long-term, even after your symptoms go away. It’s considered safer than cyclosporine, but it may lead to a higher risk of shingles, cancer, heart failure, and diseases that affect your nervous system.
What to Do if You’re Pregnant
Pregnancy may trigger GPP, usually during the third trimester. If you’re pregnant, your doctor will treat your flares quickly so they don’t lead to problems for you or your baby.
Treatment options during pregnancy include:
- Antibiotics
- Corticosteroids
- Cyclosporine
- Light therapy
Spesolimab hasn’t yet been tested in pregnancy. Other medications, like acitretin and methotrexate, may lead to complications if you’re pregnant or going to be pregnant.
What You Can Do to Soothe Your Skin
Try topical remedies to get the most out of your treatment.
Topical treatments and remedies that may help soothe your skin include:
- Corticosteroids
- Moisturizing creams
- Oatmeal baths
- Tacrolimus
- Vitamin D
- Wet wraps
Talk to your doctor about what’s safe to use on your skin.
Show Sources
Photo Credit: Moment/Getty Images
SOURCES:
American Journal of Clinical Dermatology: “Treatment Options and Goals for Patients with Generalized Pustular Psoriasis.”
Dermatology and Therapy: “Generalized Pustular Psoriasis: A Review on Clinical Characteristics, Diagnosis, and Treatment.”
Journal of the American Academy of Dermatology: “Generalized pustular psoriasis: A consensus statement from the National Psoriasis Foundation.”
American Academy of Dermatology Association: “Pustular Psoriasis: Treatment.”
Cleveland Clinic: “Pustular Psoriasis.”
National Organization for Rare Disorders: “Generalized Pustular Psoriasis.”
National Psoriasis Foundation: “Spevigo (spesolimab-sbzo).”
