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Updated: Nov 12, 2025

Author Spotlight: Self-Assessment Protocol for Predicting Psoriatic Arthritis in Psoriasis Patients
Published on: March 1, 2024
Pustular Psoriasis and Associated Musculoskeletal Disorders
Kristina Callis Duffin1, Hervé Bachelez1, Philip J Mease1
1As part of the supplement series GRAPPA 2020, this report was reviewed internally and approved by the Guest Editors for integrity, accuracy, and consistency with scientific and ethical standards. K. Callis Duffin, MD, MS, Department of Dermatology, University of Utah, Salt Lake City, Utah, USA; H. Bachelez, MD, PhD, Department of Dermatology, Hôpital Saint-Louis, AP-HP, and Laboratory of Genetic Skin Diseases, Imagine Institute, Université de Paris, Paris, France; P.J. Mease, MD, Rheumatology Research, Swedish Medical Center/ Providence St. Joseph Health and University of Washington School of Medicine, Seattle, Washington, USA; C. Rosen, Division of Dermatology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; A. Garg, MD, Chair, Department of Dermatology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA; E. Zudak, BFA, Vice President, Strategic Partnerships, WCG Trifecta, Indianapolis, Indiana, USA; O. Elkayam, MD, V. Furer, MD, Rheumatology Department, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; J.F. Merola, MD, MMSc, Harvard Medical School, Brigham and Women's Hospital, Department of Dermatology and Department of Medicine, Division of Rheumatology and Immunology, Boston, Massachusetts, USA; J. Chau, GRAPPA Patient Research Partner, Hong Kong; M. Kishimoto, MD, Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan; P.S. Helliwell, MD, PhD, Professor of Clinical Rheumatology, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Harehills Lane, Leeds, and NIHR Leeds Biomedical Research Centre, Leeds, UK. KCD received grants/is an investigator for Amgen, AbbVie, Celgene, Eli Lilly, Janssen, Bristol Myers Squibb, Stiefel, Novartis, Pfizer, Sienna, UCB, Regeneron, Boehringer Ingelheim; is on the speakers bureau for Novartis (nonpromotional only); and is a consultant/on the advisory board for Amgen, AbbVie, Celgene, Eli Lilly, Janssen, Bristol Myers Squibb, Stiefel, Novartis, Pfizer, Sienna, UCB, Ortho Dermatologic, and Boehringer Ingelheim. PJM received research grants, consultation fees, and/or speaker honoraria from AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Janssen, Novartis, Pfizer, SUN Pharma, and UCB. AG received grants/is an investigator for the National Psoriasis Foundation, UCB, Incyte; and is a consultant/on the advisory board for AbbVie, Amgen, Asana Biosciences, Bristol Myers Squibb, Boehringer Ingelheim, Incyte, Janssen, Pfizer, UCB, and Viela Biosciences. JFM is consultant and/or investigator for Merck, Bristol Myers Squibb, AbbVie, Dermavant, Eli Lilly, Novartis, Janssen, UCB, Sanofi, Regeneron, Arena, Sun Pharma, Biogen, Pfizer, EMD Sorono, Avotres, and Leo Pharma. MK receives consulting fees and/or honoraria from AbbVie, Amgen-Astellas BioPharma, Asahi-Kasei Pharma, Astellas, Ayumi Pharma, BMS, Celgene, Chugai, Daiichi-Sankyo, Eisai, Eli Lilly, Gilead, Janssen, Kyowa Kirin, Novartis, Ono Pharma, Pfizer, Tanabe-Mitsubishi, Teijin Pharma, and UCB Pharma. OE receives consulting fees or honoraria from AbbVie, Eli Lilly, Gilead, Janssen, Novartis, Roche, Pfizer, Boehringer Ingelheim, and Novartis. This paper does not require institutional review board approval. Address correspondence to Dr. K. Callis Duffin, University of Utah, 4A330 Dermatology, SOM, 30 North 1900 East, Salt Lake City, UT 84132, USA.
Pustular psoriasis (PsO) is a rare skin condition with generalized or localized forms. Recent insights into generalized pustular psoriasis (GPP) genetics are driving new drug therapies and outcome measures.
Area of Science:
- Dermatology
- Rheumatology
- Genetics
Background:
- Pustular psoriasis (PsO) is an uncommon variant of psoriasis, presenting in generalized or localized forms.
- It can involve systemic inflammation and musculoskeletal complications, including psoriatic arthritis (PsA).
- Pustulosis is also a feature of SAPHO syndrome and chronic nonbacterial osteomyelitis.
Purpose of the Study:
- To provide an overview of the cutaneous features of pustular psoriasis and SAPHO syndrome.
- To discuss recent genetic insights into generalized pustular psoriasis (GPP).
- To highlight advancements in targeted drug therapies and validated endpoints for PsO and GPP.
Main Methods:
- Review of cutaneous features of pustular psoriasis and SAPHO syndrome.
- Discussion of recent genetic findings in GPP.
- Overview of new therapeutic strategies and endpoint development.
Main Results:
- Generalized pustular psoriasis (GPP) presents as a widespread pustular eruption, potentially familial, with severe flares and systemic inflammation.
- Localized variants include palmoplantar pustulosis and acrodermatitis continua of Hallopeau.
- Patients may have co-existing plaque psoriasis and develop psoriatic arthritis.
Conclusions:
- Advances in understanding GPP genetics are paving the way for novel targeted therapies.
- Development of validated endpoints is crucial for evaluating new treatments in PsO and GPP.
- A comprehensive understanding of PsO variants and related conditions is essential for effective patient management.
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