A prospective, observational study of the epidemiology, disease characteristics and treatment outcomes of generalized...

Generalized pustular psoriasis (GPP) is a rare, severe inflammatory skin disease marked by widespread sterile pustules on erythematous skin. It poses clinical challenges due to its systemic involvement, unpredictable course and risk of serious complications.

To evaluate the clinical features, disease severity, triggers, treatment outcomes and quality of life (QoL) in patients with GPP in India.

A prospective observational study was conducted at a tertiary care hospital in North India from March 2022 to March 2025. Disease severity in patients diagnosed with GPP was determined using the Generalized Pustular Psoriasis Area and Severity Index (GPPASI). We investigated triggers, treatment response, flares and QoL; clinical data, laboratory findings and comorbidities were also analysed.

Of 857 new patients with psoriasis, 46 (5.3%) had GPP [mean age at presentation 36.2 years (SD 16.7), 63% male]. The median inpatient stay was 12 days (interquartile range 7-17), and the mean flare count was 3.1 (SD 2.5). Triggers included medications, infections, hypocalcaemia, pregnancy and COVID-19 infection. Mean latency from trigger to flare was 10.4 days (SD 8.5). Systemic inflammation was reflected in laboratory markers. Treatments included acitretin, methotrexate, ciclosporin and biologics, with combination therapy in some patients. Early remission (≥ 50% GPPASI reduction within 5 days) occurred in 75%, 67% and 65% of patients on biologics, ciclosporin and acitretin, respectively. Sustained remission at 3 months was seen in 60%, 55% and 52% of patients on biologics, ciclosporin and acitretin, respectively. Twelve patients (26%) relapsed, and 6 (13%) had persistent disease. Early responders showed significantly better sustained remission than nonresponders (P = 0.032). Mean (SD) GPPASI scores improved from 25.4 (16.9) on day 1 to 19.1 (13.7) by day 3, with parallel improvement in QoL. There were three deaths; two were COVID-19-related.

In resource-limited settings, early identification of potential triggers and personalized treatment can optimize GPP outcomes. Conventional agents remain effective and affordable alternatives to biologics for shor-term disease control.