GPP Treatment Review Highlights Limitations of Conventional Therapies and Evidence for Biologics
Treatment options for generalized pustular psoriasis (GPP) include conventional systemic agents and biologic therapies, but the supporting evidence varies considerably across treatments, according to Alice Bendix Gottlieb, MD, PhD, who reviewed GPP treatment in the United States during her session, “Generalized Pustular Psoriasis Treatment in the US,” presented at the Masterclasses in Dermatology NP/PA Institute.
Non-systemic options, including topical corticosteroids, vitamin D analogues, and vitamin A analogues, may serve as adjunctive therapies. Phototherapy was characterized as “too slow,” as was methotrexate, for which no clinical studies demonstrate efficacy in treating or preventing GPP flares.
Evidence for cyclosporine and acitretin comes from retrospective studies. Among 102 patients with GPP treated with cyclosporine, 8 responded, although recurrence was common. In another study, acitretin produced 60% to 90% skin clearance among children with pustular psoriasis, with prevention of new pustule formation within 3 days. Most lesions resolved within 4 to 6 weeks, although relapse may occur after withdrawal.
A meta-analysis of tumor necrosis factor-alpha inhibitors found favorable outcomes in 95.1% of patients. Most received infliximab (89.3%), while 8.3% received adalimumab and 2.4% received etanercept. Fifty-three adverse events were reported, and none were serious.
Studies of IL-17-targeted therapies were generally small. Among 5 patients with GPP receiving ixekizumab, 60% achieved a static Physician Global Assessment score of 0 or 1 at week 52. A phase 3 Japanese study of brodalumab enrolled 12 patients, with 10 completing treatment.
Guselkumab was evaluated in a phase 3, multicenter, open-label Japanese study of 10 patients. Treatment success was observed within 1 week in 5 patients (50%). By week 52, “treatment success was achieved by all 8 patients who completed the study.”
Dr Gottlieb highlighted the limited and heterogeneous evidence supporting many GPP therapies, with much of the available biologic data derived from small, open-label studies.
Reference
Gottlieb AB. Generalized pustular psoriasis treatment in the US. Presented at: Masterclasses in Dermatology NP/PA Institute; October 17–18, 2026; Dallas, TX.
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