Generalized pustular psoriasis may be caused or triggered by various factors, including genetic mutations, infections, and certain medications.
Generalized pustular psoriasis (GPP) is a severe form of pustular psoriasis, a group of conditions known for causing breakouts of painful pus-filled lesions (pustules).
What makes GPP different from other types of pustular psoriasis is that it typically affects large areas of your body at once. It can also be accompanied by life threatening symptoms, such as rapid pulse, high fever, and dehydration.
GPP is considered rare, affecting only about 1 in 10,000 people in the United States. The exact causes are not known. However, as with other types of inflammatory diseases, there are triggers that might contribute to flare-ups.
Learn more about the possible causes and triggers of GPP that you may wish to discuss with a doctor.
There isn’t a single known cause of GPP, and some people may develop this condition without any obvious triggers.
However, researchers believe there are a variety of possible factors that can contribute to the onset of this condition, including a combination of genetic and environmental factors.
Genes
It is possible to have a genetic predisposition to GPP. In particular,
You’re also more likely to have this variation if you have GPP symptoms that affect your mouth and no personal history of plaque psoriasis.
Some environmental factors, including certain infections and medications, may also cause GPP, particularly in those who have a genetic predisposition to this condition.
Infections
Possible infections that may contribute to GPP development include:
- COVID-19
- Epstein-Barr virus
- chickenpox
- shingles
- strep throat
Medications
Some types of medications may also contribute to GPP. People who develop GPP might have a history of taking certain immune-suppressing drugs and then experience symptoms once they stop taking them.
Examples of immune-suppressing drugs associated with GPP development include the following:
- corticosteroids
- cyclosporine (Gengraf, Neoral, Sandimmune)
- rituximab (Rituxan, Truxima)
- ustekinumab (Stelara)
Other medications may also be linked to GPP, such as:
- certain antibiotics
- codeine and morphine
- aspirin
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- certain anti-hypertensive medications, such as diltiazem (Cartia XT, Tiazac) and ramipril (Altace)
- terbinafine (Lamisil, Terbinex), a type of antifungal drug
Interleukin-17 (IL-17) and tumor necrosis factor-a (TNF-a) inhibitors prescribed for other inflammatory conditions such as Crohn’s disease and plaque psoriasis may also lead to GPP in some people.
On average, people who develop GPP after taking certain medications might start experiencing symptoms within 2 to 3 weeks.
Vaccinations may also be a possible trigger for GPP development. Examples include those for H1N1 and COVID-19.
Despite these possible links, it’s important that you take all medications as prescribed by your doctor and talk with them about your concerns about side effects. In most cases, the benefits of taking a particular medication or vaccine outweigh the risk of GPP development.
Possible co-morbidities
Also, while not a direct cause or trigger, more than half of people with GPP also have a history of plaque psoriasis. Other possible comorbidities
- inflammatory polyarthritis
- obesity
- metabolic syndrome
- diabetes
- high cholesterol
- high blood pressure
A trigger refers to a situation or factor that can possibly lead to symptomatic flares. These can also vary between individuals. However, common triggers of a GPP flare may include:
- stress
- low calcium levels, which
may be related to hyperparathyroidism (low levels of the parathyroid hormone) - recent injuries or infections
- menstruation
- pregnancy (pustular psoriasis of pregnancy), especially in the third trimester
- too much sunlight exposure
- smoking
Also, taking certain medications, such as IL-17 and TNF-a inhibitors, can possibly trigger flares in people who already have GPP.
In addition to widespread pustules, researchers have reported that the most common skin symptoms of GPP are:
- burning
- severe itching
- pain
- redness or other color changes
- swelling
- dry scales
However, despite its cutaneous signs and possible flu-like symptoms, such as fever and chills, GPP is not contagious.
Like other types of psoriasis, GPP is considered autoimmune. These conditions are not infectious diseases and cannot spread to others upon contact.
There’s currently no cure for GPP, and due to the number of potential causes, there are no known preventive measures.
You can, however, reduce the number of flares you experience by decreasing some of the known triggers. You can help by:
- practicing stress management on a daily basis
- quitting smoking
- seeking treatment for infections
- decreasing your alcohol consumption
- reducing the amount of time you spend in the sun
It’s also important to call a doctor right away if you develop GPP symptoms before this condition becomes life threatening.
Doctors may consider biologics, immunosuppressants, or oral retinoids to help quickly reduce the underlying inflammation causing your flares.
On average, a GPP flare can last between 2 to 5 weeks. Hospitalization may be required if symptoms become life threatening, or if you develop complications such as hepatitis or sepsis.
GPP is a severe type of pustular psoriasis, with symptoms related to significant underlying inflammation.
While researchers have not identified a single cause of the inflammation that can lead to GPP, it’s thought that a combination of genes and environmental factors may lead to alterations in your immune system.
Any suspected GPP flare requires immediate medical attention to prevent possible life threatening complications. Also, once you have GPP, you may be able to reduce the number of flares you experience by avoiding any known triggers.
If you or a loved one has GPP, consider talking with a doctor about ways you can manage this condition long-term. While there are many unknowns related to this condition, there are treatments to help manage symptoms of a flare-up. Additionally, new treatments are continuously being investigated.