Clinical characteristics and heterogeneity of generalized pustular psoriasis: A comparative study in a large retrospective cohort

Abstract

Generalized pustular psoriasis (GPP) is a rare and potentially life‐threatening skin disease and the clinical heterogeneity of which is largely unknown. Retrospective cohort analysis was conducted on hospitalized GPP patients between January 2010 and November 2022. A total of 416 patients with GPP and psoriasis vulgaris (PV) respectively were included, matched 1:1 by sex and age. The heterogeneity of GPP was stratified by PV history and age. Compared with PV, GPP was significantly associated with prolonged hospitalization (11.7 vs. 10.3 day, p < 0.001), elevated neutrophil lymphocyte ratio (NLR) (5.93 vs. 2.44, p < 0.001) and anemia (13.9% vs. 1.2%, p < 0.001). Moreover, GPP alone (without PV history) was a relatively severer subtype with higher temperature (37.6°C vs. 38.0°C, p = 0.002) and skin infections (5.2% vs. 11.4%, p = 0.019) than GPP with PV. For patients across different age, compared with juvenile patients, clinical features support a severer phenotype in middle‐aged, including higher incidence of anaemia (7.5% vs. 16.0%, p = 0.023) and NLR score (3.83 vs. 6.88, p < 0.001). Interleukin‐6 (r = 0.59), high density lipoprotein cholesterol (r = −0.56), albumin (r = −0.53) and C‐reactive protein‐to‐albumin ratio (r = 0.49) were the most relevant markers of severity in GPP alone, GPP with PV, juvenile and middle‐aged GPP, respectively. This retrospective cohort suggests that GPP is highly heterogeneous and GPP alone and middle‐aged GPP exhibit severe disease phenotypes. More attention on the heterogeneity of this severe disease is warranted to meet the unmet needs and promote the individualized management of GPP.

Generalized Pustular Psoriasis and Systemic Organ Dysfunctions

“…A retrospective cohort analysis was conducted on GPP patients hospitalized between January 2010 and November 2022 to elucidate the influence of GPP in anemia [ 103 ]. In a comparative study involving 416 patients, each diagnosed with GPP and psoriasis vulgaris, anemia was found to be significantly more prevalent in patients with GPP than in those with PV (13.9% vs. 1.2%, p < 0.001) [ 103 ]. Additionally, a separate cohort study of 860 GPP patients highlighted the impact of severe GPP on anemia [ 104 ].…”