![GPP Flares](/disease/gpp/sites/default/files/2022-06/Recognizing-gpp-flares-banner.png)
RECOGNISING GPP FLARES
WHAT IS A GPP FLARE?
Generalized Pustular Psoriasis (GPP) flares are characterised by eruptions of painful, sterile pustules.1
WHAT TRIGGERS GPP FLARES?
Recognising the triggers of flares early may help in managing your patient's disease. GPP flares can be triggered by2,3:
![Sunlight Sunlight](/disease/gpp/sites/default/files/2021-09/Sunlight.png)
SUNLIGHT
![Upper respiratory infections Upper respiratory infections](/disease/gpp/sites/default/files/2021-09/Upper-respiratory-TRACT-infections.png)
UPPER RESPIRATORY TRACT INFECTIONS
![Certain medication Certain medication](/disease/gpp/sites/default/files/2021-09/Certain-medications.png)
CERTAIN MEDICATIONS AND SUDDEN WITHDRAWAL OF STEROIDS
![Stress Stress](/disease/gpp/sites/default/files/2021-09/Stress.png)
STRESS
![Infection Infection](/disease/gpp/sites/default/files/2021-09/Infection.png)
INFECTION
![Pregnancy Pregnancy](/disease/gpp/sites/default/files/2021-09/Pregnancy.png)
PREGNANCY
HOW GPP FLARES CAN MANIFEST ON SKIN
The symptoms of GPP most cited by dermatologists include pustules and worsening lesions.3
![GPP Pustules GPP Pustules](/disease/gpp/sites/default/files/2022-06/gpp-pustules-2.png)
![GPP Pustules GPP Pustules](/disease/gpp/sites/default/files/2022-06/gpp-pustules-3.png)
OTHER FLARE SYMPTOMS MAY INCLUDE3-7:
![GPP Symptoms GPP Symptoms](/disease/gpp/sites/default/files/2021-09/Itching.png)
ITCHING
![GPP Symptoms GPP Symptoms](/disease/gpp/sites/default/files/2021-09/Scaling.png)
SCALING
![GPP Symptoms GPP Symptoms](/disease/gpp/sites/default/files/2021-09/Dryness.png)
DRYNESS
![GPP Symptoms GPP Symptoms](/disease/gpp/sites/default/files/2021-09/ERYTHEMA.png)
ERYTHEMA
![GPP Symptoms GPP Symptoms](/disease/gpp/sites/default/files/2021-09/pain.png)
PAIN
![GPP Symptoms GPP Symptoms](/disease/gpp/sites/default/files/2021-09/Swelling.png)
INFLAMMATION
![GPP Symptoms GPP Symptoms](/disease/gpp/sites/default/files/2021-09/Burning-sensation.png)
BURNING SENSATION
![Discomfort Discomfort](/disease/gpp/sites/default/files/2022-06/discomfort.png)
DISCOMFORT
![GPP Symptoms GPP Symptoms](/disease/gpp/sites/default/files/2021-09/Fever.png)
FEVER
![GPP Symptoms GPP Symptoms](/disease/gpp/sites/default/files/2021-09/LEUKOCYTOSIS.png)
LEUKOCYTOSIS
![GPP Symptoms GPP Symptoms](/disease/gpp/sites/default/files/2021-09/Fatigue.png)
FATIGUE
![GPP Symptoms GPP Symptoms](/disease/gpp/sites/default/files/2021-09/Headache.png)
HEADACHE
DR STROBER PROVIDES MORE INSIGHT ON HOW GPP FLARES MAY MANIFEST IN PATIENTS
These symptoms and extracutaneous manifestations can incapacitate patients during a flare.”
Dr Bruce Strober
THE CLINICAL COURSE OF GPP FLARES IS UNPREDICTABLE8
GPP is heterogenous. Flare symptoms and triggers can vary and even present differently within the same patient. Previous GPP flare episodes do not indicate the severity or duration of the next flare.3,8
THE GPPGA SCORE CAN BE USED FOR ASSESSING FLARES9
The GPPGA is a scoring tool that can be used to assess the severity of flare symptoms. It was created by modifying the PGA, a clinical tool used by dermatologists to assess psoriasis.9
![GPPGA Scoring Tool Guide GPPGA Scoring Tool Guide](/disease/gpp/sites/default/files/2022-08/2gppga_5_0.jpg)
All images ©2022 Boehringer Ingelheim International, GmbH. All rights reserved.
TO DETERMINE A PATIENT’S GPPGA SCORE9:
![Assess the pustules, erythema, and scaling skin Assess the pustules, erythema, and scaling skin](/disease/gpp/sites/default/files/2022-06/access-the-pustules.png)
1.
ASSESS THE PUSTULES, ERYTHEMA, AND SCALING SKIN
![Grade each individual component Grade each individual component](/disease/gpp/sites/default/files/2022-06/grade-each-individual-component.png)
2.
GRADE EACH INDIVIDUAL COMPONENT
![Calculate the average to determine the composite score Calculate the average to determine the composite score](/disease/gpp/sites/default/files/2022-06/calculate-the-avarage.png)
3.
CALCULATE THE AVERAGE TO DETERMINE THE COMPOSITE SCORE
![SEE HOW THE IL-36 PATHWAY PLAYS A ROLE IN GPP12 SEE HOW THE IL-36 PATHWAY PLAYS A ROLE IN GPP12](/disease/gpp/sites/default/files/2022-06/SEE%20HOW%20THE%20IL-36%20PATHWAY%20PLAYS%20A%20ROLE%20IN%20GPP.jpg)
LEARN ABOUT THE IMPACT OF GPP ON PATIENTS2,10
GPPGA=Generalized Pustular Psoriasis Physician Global Assessment; PGA=Physician Global Assessment.
REFERENCES
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Benjegerdes KE, Hyde K, Kivelevitch D, Mansouri B. Pustular psoriasis: pathophysiology and current treatment perspectives. Psoriasis (Auckl). 2016;6:131-144. doi:10.2147/PTT.S98954
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Kharawala S, Golembesky AK, Bohn RL, Esser D. The clinical, humanistic, and economic burden of generalized pustular psoriasis: a structured review. Expert Rev Clin Immunol. 2020;16(3):239-252. doi:10.1080/1744666X.2019.1708193
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Strober B, Kotowsky N, Medeiros R, et al. Unmet medical needs in the treatment and management of generalized pustular psoriasis flares: evidence from a survey of Corrona registry dermatologists. Dermatol Ther (Heidelb). 2021;11(2):529-541. doi:10.1007/s13555-021-00493-0
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Skalicky A, Rentz A, Esser D, Thoma C, Gloede T. Symptom experience of patients with generalized pustular psoriasis (GPP). Value in Health. 2020;23(suppl 1):S345. Abstract: PRO89. doi:10.1016/j.jval.2020.04.1310
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Bachelez H. Pustular psoriasis: the dawn of a new era. Acta Derm Venereol. 2020;100(3):adv00034. doi:10.2340/00015555-3388
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Choon SE, Lai NM, Mohammad NA, Nanu NM, Tey KE, Chew SF. Clinical profile, morbidity, and outcome of adult-onset generalized pustular psoriasis: analysis of 102 cases seen in a tertiary hospital in Johor, Malaysia. Int J Dermatol. 2014;53(6):676-684. doi:10.1111/ijd.12070
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Shah M, Al Aboud DM, Crane JS, Kumar S. Pustular psoriasis. StatPearls. Updated August 10, 2020. Accessed January 27, 2022. https://www.ncbi.nlm.nih.gov/books/NBK537002/
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Bachelez H. Pustular psoriasis and related pustular skin diseases. Br J Dermatol. 2018;178(3):614-618. doi:10.1111/bjd.16232
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Choon SE, Lebwohl MG, Marrakchi S, et al. Study protocol of the global Effisayil 1 phase II, multicentre, randomised, double-blind, placebo-controlled trial of spesolimab in patients with generalized pustular psoriasis presenting with an acute flare. BMJ Open. 2021;11(3):e043666. doi:10.1136/bmjopen-2020-043666
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Gooderham MJ, Van Voorhees AS, Lebwohl MG. An update on generalized pustular psoriasis. Expert Rev Clin Immunol. 2019;15(9):907-919. doi:10.1080/1744666X.2019.1648209