In a survey of dermatologists based in North America, the clinical manifestations of skin symptoms are the driving factor in the selection of treatment options for generalized pustular psoriasis (GPP). The results and analysis of the survey were presented at Maui Derm Connect 2021.

As dermatology knows, GPP is a rare, systemic autoinflammatory disease that presents as acute flares of diffuse dermatitis and sterile pustules. If left untreated, these flares can progress to complications such as sepsis, renal failure, and congestive heart failure. Patients with GPP may continue to experience disease symptoms such as erythema, erythroderma, and desquamation even after treatment of their flare. Due to the lack of approved treatments for GPP, many dermatologists treat GPP similarly to plaque psoriasis.

To better understand this disease, the survey of North American dermatologists sought to explore the most commonly used therapies, their perceived adequacy, and the challenges faced in treatment of GPP.

In total, 29 dermatologists who participate in the Corrona Psoriasis Regsitry and who had treated adult patients with GPP within the previous 5 years completed the 28-question survey. Multiple choice items asked about flare onset and diagnosis, flare frequency and duration, treatment of flares and residual disease, and physician overall experience with GPP.

When it came to treatment, the respondents most commonly initiated, switched, or added a treatment for a GPP flare when the patient presented with worsening skin lesions (97% of respondents) and pustules (90%). This was followed by patient reported symptoms (76%) and erythema (72%).

Nonbiologic agents that were somewhat likely or very likely to be prescribed were cyclosporine (85%), and either acitretin or isotretinoin (55%). A number of other agents were not as commonly utilized, with methotrexate, apremilast, oral steroids, and other nonbiologics being 49%, 68%, 69%, and 75%, respectively, very unlikely to somewhat unlikely to be prescribed.

As for biologic therapies, the most commonly used were infliximab (53%), ixekizumab (52%), adalimumab (41%), and secukinumab (41%). The least prescribed were golimumab (85%), etanercept (82%), and certolizumab pegol (68%).

Most respondents indicated that the existing treatment options are mostly or always adequate (79% and 14%, respectively) for managing GPP flares. However, 83% of respondents stated that patients still experienced residual symptoms and 72% said treatments were too slow in controlling flares.

Residual disease was somewhat likely to very likely to be treated with topical steroids (83%), secukinumab (62%), ixekizumab (62%), and adalimumab (56%). These therapies were reported to be adequate most of the time by 83% of respondents. Further, 43% of participants who had treated three or more patients in the past 5 years said that the existing treatment options rarely or very rarely prevented new flares, and 56% of dermatologists who had patients with two or more flares per year reported inadequacy at least sometimes in the treatment of residual disease.

“These results highlight the unmet need for effective and novel treatments with a faster onset of action, that can provide complete disease resolution, and have the ability to prevent future flares,” concluded the study authors.

Reference
Strober B, Lebwohl M, Kotowsky N, et al. Perspectives on generalized pustular psoriasis treatment in North America: survey results from dermatologists in the Corrona Psoriasis Registry. Poster presented at: Maui Derm Connect; January 25-29, 2021; Maui, HI.