Generalized pustular psoriasis: a review and update on treatment

J Eur Acad Dermatol Venereol. 2018 Oct;32(10):1645-1651. doi: 10.1111/jdv.14949. Epub 2018 Apr 11.


Generalized pustular psoriasis (GPP) is a subtype of pustular psoriasis characterized by painful and occasionally disfiguring cutaneous manifestations with sepsis-like systemic symptoms. Affecting any age and race, GPP can occur with other forms of psoriasis or by itself. Stimuli for flares include medications, infections and environmental triggers. The interleukin family and caspase recruitment domain family have been implicated in its pathogenesis. Other forms of pustular psoriasis include impetigo herpetiformis, palmoplantar pustular psoriasis, annular pustular psoriasis and acrodermatitis continua of Hallopeau. Treatment is not well established, but includes the use of retinoids, methotrexate, cyclosporine, corticosteroids, TNF-alpha inhibitors, topical therapy and phototherapy. The use of TNF-alpha inhibitors may result in the formation of antidrug antibodies and should be administered with methotrexate.

Publication types

  • Review

MeSH terms

  • Antibodies, Neutralizing
  • Biological Products / immunology
  • Biological Products / therapeutic use
  • Contraindications, Drug
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • PUVA Therapy
  • Psoriasis / diagnosis*
  • Psoriasis / drug therapy*
  • Psoriasis / etiology
  • Psoriasis / pathology


  • Antibodies, Neutralizing
  • Biological Products
  • Immunosuppressive Agents