Treatment of acute generalized pustular psoriasis in adults

GPP: generalized pustular psoriasis; IL: interleukin.

* Efficacy data for acute GPP therapies are limited, and the relative efficacy of treatments is unclear. Our selection of spesolimab is based on randomized trial data that support the efficacy of spesolimab for acute GPP. If spesolimab is not available or has not been effective, we suggest IL-17 or IL-23 inhibitors given their favorable adverse effect profiles. Infliximab or cyclosporine may be used as an alternative or later-line option.

¶ Spesolimab is given as a single dose, with a second dose after 1 week if needed based on response.

Δ We typically transition patients on cyclosporine to other therapies because of concern for potentially serious adverse effects of long-term cyclosporine therapy.

◊ We tend to taper nonbiologic therapies but stop biologic therapies with the plan to restart therapy if needed. Shared decision-making plays a role in the decision to stop treatment; earlier treatment cessation may be a reasonable alternative for patients with an initial episode of GPP with a clear trigger. A more cautious approach to treatment reduction is prudent for patients with a history of severe disease.

§ Hospital admission is often necessary for acute GPP. The decision to hospitalize a patient is made based on global consideration of the severity of illness, vital sign stability, fluid and electrolyte status, and concern for systemic infection.