Researchers looked at how doctors treated patients with generalized pustular psoriasis (GPP), a serious skin condition that causes widespread pustules and inflammation. By studying medical records from 2,630 patients between 2015 and 2020, they found that doctors most often prescribed steroid creams and steroid pills as first-line treatments. However, the study revealed that patients who had both GPP and regular psoriasis received newer biologic medications more often than those with GPP alone. The findings suggest that treatment approaches for GPP were inconsistent during this period, partly because there were no FDA-approved medications specifically designed for GPP at that time.

The Quick Take

  • What they studied: How doctors in the United States were treating patients with generalized pustular psoriasis (GPP) and what medications they prescribed most often
  • Who participated: 2,630 patients with GPP identified through insurance claims records between 2015 and 2020. The group included 1,246 patients with GPP only and 1,384 patients who had both GPP and regular plaque psoriasis
  • Key finding: Steroid creams were the most commonly prescribed treatment (51-56% of patients), followed by steroid pills (40-42%). However, newer biologic medications were prescribed to only 21-40% of patients, with those who also had regular psoriasis receiving biologics more frequently than those with GPP alone
  • What it means for you: If you have GPP, your doctor may start with steroid treatments, but the approach to your care may vary depending on whether you also have regular psoriasis. Newer biologic medications exist but may not be offered equally to all GPP patients. Talk with your dermatologist about all available treatment options for your specific situation

The Research Details

Researchers examined insurance claim records from a large database to identify patients diagnosed with generalized pustular psoriasis between 2015 and 2020. They looked at what medications were prescribed during two one-year periods: the year after diagnosis and the year before diagnosis. This approach allowed them to see how treatment patterns changed once doctors knew a patient had GPP. The study divided patients into three groups: those with GPP only, those with both GPP and regular psoriasis, and all GPP patients combined. By comparing medication use before and after diagnosis, researchers could understand what treatments doctors actually chose in real-world practice.

This type of study is important because it shows what doctors actually do in everyday practice, rather than what guidelines recommend. Since GPP is rare and serious, there were no clear treatment guidelines during the study period. Understanding real-world treatment patterns helps doctors learn from each other and helps patients know what to expect. It also reveals gaps in treatment options, which is important information for developing new medications.

This study used a large, real-world database of insurance claims, which provides reliable information about actual prescribing patterns. However, the data only shows what was prescribed, not whether patients actually took the medications or how well they worked. The study period ended before the first FDA-approved GPP-specific medication became available, so it doesn’t reflect current treatment options. The researchers clearly identified patients using diagnostic codes, which is a reliable method.

What the Results Show

Topical corticosteroids (steroid creams) were the most frequently prescribed treatment after GPP diagnosis, used in about 52-56% of patients depending on whether they also had regular psoriasis. Systemic corticosteroids (steroid pills taken by mouth) were the second most common treatment, prescribed to 40-42% of patients. Interestingly, the use of both types of steroids actually decreased after diagnosis compared to before diagnosis, suggesting doctors may have been trying other approaches once they confirmed GPP. In contrast, other treatments like biologic medications (newer drugs that target specific parts of the immune system) and phototherapy (light treatment) were prescribed more often after diagnosis. Patients who had both GPP and regular psoriasis were significantly more likely to receive biologic medications (40% vs 22%) and other systemic treatments compared to those with GPP alone.

The study found that topical vitamin D derivatives, retinoids, systemic non-biologic medications, and phototherapy were all prescribed more frequently after GPP diagnosis than before. This suggests that once doctors confirmed a GPP diagnosis, they expanded the range of treatments they tried. The fact that steroid use decreased after diagnosis is noteworthy because previous research has warned that stopping steroids abruptly can trigger GPP flares. This pattern suggests doctors may have been attempting to reduce steroid dependence, though the study doesn’t explain why or whether this was intentional.

This study provides the first large-scale look at how GPP was actually treated in the United States during a specific time period. Previous research has mostly focused on small case reports or clinical trials. The findings align with concerns raised in medical literature that GPP treatment was inconsistent and that steroids were being used despite warnings about flare risks with withdrawal. The study also confirms what doctors have observed: patients with both GPP and regular psoriasis tend to receive more advanced treatments, possibly because doctors are more familiar with treating regular psoriasis with biologics.

The study only looked at what was prescribed, not whether patients took the medications or how well they worked. Insurance claims data may miss treatments paid for out-of-pocket or provided in hospital settings. The study period (2015-2020) ended before the first FDA-approved GPP-specific medication became available, so it doesn’t reflect current treatment options. The study couldn’t determine why doctors made certain treatment choices or whether they followed any specific guidelines. Additionally, the data only includes insured patients, so results may not apply to uninsured or underinsured populations.

The Bottom Line

If you have GPP, expect that your doctor may start with topical or systemic corticosteroids as initial treatment. However, discuss with your dermatologist whether biologic medications or other advanced treatments might be appropriate for your situation, especially if you also have regular psoriasis. Ask about the risks and benefits of long-term steroid use and whether there are newer treatment options available. Work with your doctor to develop a treatment plan that addresses your specific needs and minimizes the risk of flares. (Confidence level: Moderate - based on real-world practice patterns, though individual treatment should be personalized)

This research is most relevant for patients with GPP, their family members, and dermatologists treating GPP. It’s particularly important for people with GPP who feel their treatment isn’t working or who are concerned about long-term steroid use. People with regular plaque psoriasis should know that GPP is a different, more serious condition requiring different treatment approaches. This information is less relevant for people without psoriasis, though it may help them understand the challenges of treating rare skin diseases.

Treatment effects vary greatly depending on which medication is used. Topical steroids may show improvement in days to weeks, while systemic treatments may take 2-4 weeks to show full effects. Biologic medications typically require 4-12 weeks to reach maximum effectiveness. However, GPP can be unpredictable, and some patients may experience flares despite treatment. Discuss realistic timelines with your doctor based on your specific treatment plan.

Want to Apply This Research?

  • Track daily skin symptoms using a simple 1-10 scale (1=clear skin, 10=severe pustules and inflammation). Also log which medications you’re taking each day and any side effects. This helps you and your doctor see patterns and determine which treatments work best for you
  • Set daily reminders to apply topical treatments at the same time each day to build consistency. If prescribed systemic medications, use the app to track doses and refill dates. Document any triggers you notice (stress, certain foods, weather) that seem to worsen your GPP, and share this information with your doctor
  • Take weekly photos of affected skin areas in consistent lighting to visually track improvement or worsening. Monthly, review your symptom scores and medication log with your doctor to assess whether your current treatment plan is working. If you experience a flare, immediately log details about what happened and notify your healthcare provider. This long-term tracking helps identify the most effective treatment approach for your individual case

This research describes how doctors treated GPP patients during 2015-2020 and does not constitute medical advice. GPP is a serious, potentially life-threatening condition that requires professional medical care. Do not start, stop, or change any medications without consulting your dermatologist or healthcare provider. Treatment decisions should be individualized based on your specific condition, medical history, and other medications. If you have GPP or suspect you might, seek care from a board-certified dermatologist. In case of severe symptoms or emergency, seek immediate medical attention.