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GPP Flares

RECOGNISING GPP FLARES

WHAT IS A GPP FLARE?

Generalized Pustular Psoriasis (GPP) flares are characterised by eruptions of painful, sterile pustules.1

WHAT TRIGGERS GPP FLARES?

Recognising the triggers of flares early may help in managing your patient's disease. GPP flares can be triggered by2,3:

Sunlight

SUNLIGHT

Upper respiratory infections

UPPER RESPIRATORY TRACT INFECTIONS

Certain medication

CERTAIN MEDICATIONS AND SUDDEN WITHDRAWAL OF STEROIDS

Stress

STRESS

Infection

INFECTION

Pregnancy

PREGNANCY

HOW GPP FLARES CAN MANIFEST ON SKIN

The symptoms of GPP most cited by dermatologists include pustules and worsening lesions.3

GPP Pustules
GPP Pustules

OTHER FLARE SYMPTOMS MAY INCLUDE3-7:

GPP Symptoms

ITCHING

GPP Symptoms

SCALING

GPP Symptoms

DRYNESS

GPP Symptoms

ERYTHEMA

GPP Symptoms

PAIN

GPP Symptoms

INFLAMMATION

GPP Symptoms

BURNING SENSATION

Discomfort

DISCOMFORT

GPP Symptoms

FEVER

GPP Symptoms

LEUKOCYTOSIS

GPP Symptoms

FATIGUE

GPP Symptoms

HEADACHE

DR STROBER PROVIDES MORE INSIGHT ON HOW GPP FLARES MAY MANIFEST IN PATIENTS

These symptoms and extracutaneous manifestations can incapacitate patients during a flare.”
Dr Bruce Strober

THE CLINICAL COURSE OF GPP FLARES IS UNPREDICTABLE8

GPP is heterogenous. Flare symptoms and triggers can vary and even present differently within the same patient. Previous GPP flare episodes do not indicate the severity or duration of the next flare.3,8

THE GPPGA SCORE CAN BE USED FOR ASSESSING FLARES9 

The GPPGA is a scoring tool that can be used to assess the severity of flare symptoms. It was created by modifying the PGA, a clinical tool used by dermatologists to assess psoriasis.9

GPPGA Scoring Tool Guide

All images ©2022 Boehringer Ingelheim International, GmbH. All rights reserved.

TO DETERMINE A PATIENT’S GPPGA SCORE9:

Assess the pustules, erythema, and scaling skin

1.

ASSESS THE PUSTULES, ERYTHEMA, AND SCALING SKIN

Grade each individual component

2.

GRADE EACH INDIVIDUAL COMPONENT

Calculate the average to determine the composite score

3.

CALCULATE THE AVERAGE TO DETERMINE THE COMPOSITE SCORE

GPPGA=Generalized Pustular Psoriasis Physician Global Assessment; PGA=Physician Global Assessment. 

REFERENCES

  1. Benjegerdes KE, Hyde K, Kivelevitch D, Mansouri B. Pustular psoriasis: pathophysiology and current treatment perspectives. Psoriasis (Auckl). 2016;6:131-144. doi:10.2147/PTT.S98954 

  2. Kharawala S, Golembesky AK, Bohn RL, Esser D. The clinical, humanistic, and economic burden of generalized pustular psoriasis: a structured review. Expert Rev Clin Immunol. 2020;16(3):239-252. doi:10.1080/1744666X.2019.1708193 

  3. Strober B, Kotowsky N, Medeiros R, et al. Unmet medical needs in the treatment and management of generalized pustular psoriasis flares: evidence from a survey of Corrona registry dermatologists. Dermatol Ther (Heidelb). 2021;11(2):529-541. doi:10.1007/s13555-021-00493-0 

  4. Skalicky A, Rentz A, Esser D, Thoma C, Gloede T. Symptom experience of patients with generalized pustular psoriasis (GPP). Value in Health. 2020;23(suppl 1):S345. Abstract: PRO89. doi:10.1016/j.jval.2020.04.1310 

  5. Bachelez H. Pustular psoriasis: the dawn of a new era. Acta Derm Venereol. 2020;100(3):adv00034. doi:10.2340/00015555-3388 

  6. Choon SE, Lai NM, Mohammad NA, Nanu NM, Tey KE, Chew SF. Clinical profile, morbidity, and outcome of adult-onset generalized pustular psoriasis: analysis of 102 cases seen in a tertiary hospital in Johor, Malaysia. Int J Dermatol. 2014;53(6):676-684. doi:10.1111/ijd.12070 

  7. Shah M, Al Aboud DM, Crane JS, Kumar S. Pustular psoriasis. StatPearls. Updated August 10, 2020. Accessed January 27, 2022. https://www.ncbi.nlm.nih.gov/books/NBK537002/ 

  8. Bachelez H. Pustular psoriasis and related pustular skin diseases. Br J Dermatol. 2018;178(3):614-618. doi:10.1111/bjd.16232 

  9. Choon SE, Lebwohl MG, Marrakchi S, et al. Study protocol of the global Effisayil 1 phase II, multicentre, randomised, double-blind, placebo-controlled trial of spesolimab in patients with generalized pustular psoriasis presenting with an acute flare. BMJ Open. 2021;11(3):e043666. doi:10.1136/bmjopen-2020-043666

  10. Gooderham MJ, Van Voorhees AS, Lebwohl MG. An update on generalized pustular psoriasis. Expert Rev Clin Immunol. 2019;15(9):907-919. doi:10.1080/1744666X.2019.1648209