In this episode of Topical Conversations, Raj Chovatiya, MD, PhD, and Laura Ferris, MD, PhD, explore the complexities of generalized pustular psoriasis (GPP), highlighting its chronic nature and the challenges it poses for both patients and providers. They stress the importance of recognizing and treating GPP not just during acute flares but throughout its chronic course. 

Longitudinal disease activity and the patient-provider disconnect 

Dr Chovatiya emphasizes that while some patients with GPP may present for the first time in the hospital with severe flares requiring intensive care, many others experience longitudinal activity with symptoms that persist over time. These patients may have less severe manifestations, such as scaly or pustular lesions covering only a small percentage of their body surface area. There exists a disconnect between patients and HCPs, with patients often downplaying their chronic symptoms and HCPs underestimating the severity of the disease unless it presents in its most extreme form. 

Continuous management and between-flare challenges 

Dr Ferris echoes the sentiment that GPP is a chronic condition that requires continuous management. She emphasizes 2 key aspects of care: preventing flares and addressing the symptoms that persist between flares. Despite not reaching the severity seen during hospitalization, patients still endure discomfort and impairment in their day-to-day lives. However, historically there has been a lack of effective treatment options for managing these in-between symptoms. 

A comprehensive approach to GPP management Dr Chovatiya advocates for a comprehensive approach to managing GPP, consisting of 3 steps: treating acute flares, preventing future flares, and providing ongoing control to minimize disease activity over time. By adopting this strategy, the goal is to achieve long-term disease remission or low disease activity. He also suggests that GPP may be more prevalent than commonly thought, emphasizing the need for improved diagnostic accuracy and targeted therapies. 

Future directions 

Both physicians acknowledge the current limitations in accurately diagnosing and effectively treating GPP, particularly during periods of low disease activity. They advocate for the development of more targeted therapies that address the underlying mechanisms of the disease to better manage patients' symptoms and improve their quality of life. Ultimately, their discussion underscores the importance of recognizing GPP as a chronic condition that requires continuous monitoring and intervention to minimize its impact on patients.