Generalized pustular psoriasis (GPP) is considered a rare and severe form of psoriasis that may be treated with a combination of oral medications, topical treatments, and more.

Generalized pustular psoriasis (GPP), also known as von Zumbusch psoriasis, is one of two types of pustular psoriasis and is considered the most severe.

People with GPP may experience multiple small, pus-filled bumps called pustules that can affect large areas of the body. Severe and sudden flare-ups can cause widespread pustules, itching, weakness, and flu-like symptoms.

The National Psoriasis Foundation reports that GPP occurs in 1 in 10,000 people in the United States. Due to its rarity and sudden onset of severe flare-ups, GPP can be challenging to manage.

Treatment for GPP largely depends on its cause, severity, and whether you have any other known health conditions.

There’s no single effective treatment for GPP. However, treatments are available that can help reduce inflammation and symptoms while also lowering the risk of serious complications.

Learn more about what GPP treatment options are available, how they work, and other important key information to discuss with a doctor.

When to seek immediate treatment for GPP

Skin pustules accompanied by fever and chills may indicate a potentially life threatening GPP flare. Get immediate medical care if you experience flu-like symptoms along with other signs of GPP.

Biologics work by targeting small inflammation-inducing proteins called cytokines. These targeted therapies are increasingly being used to treat a variety of inflammatory and autoimmune conditions, including GPP.

Spesolimab (Spevigo) is currently the only medication the Food and Drug Administration (FDA) has approved for the specific treatment of GPP. It can be administered intravenously in a medical setting or prescribed as self-injectable doses for at-home use.

This medication is also sometimes used to treat severe GPP flare-ups to help prevent life threatening complications like sepsis and organ failure.

Infliximab (Remicade) is another type of biologic that may be used to help treat pustules and other symptoms of a sudden GPP flare.

Other types of biologics, such as ixekizumab (Taltz) or secukinumab (Cosentyx), may be used when initial treatment with spesolimab or infliximab doesn’t improve symptoms.

New biologics are constantly being investigated and approved for conditions like GPP.

Oral treatments for GPP are designed to help decrease symptoms that develop with flare-ups. Some of the options commonly prescribed include:

  • Apremilast (Otezla): This systemic treatment may improve acute (severe) GPP symptoms within 2 to 3 weeks. A dermatologist (a doctor who specializes in skin conditions) might recommend apremilast as a first-line treatment if you cannot tolerate other medications, have other underlying health conditions, or have an acute infection.
  • Cyclosporine (Gengraf, Neoral, Sandimmune): Traditionally used to prevent organ rejection in new recipients, this immunosuppressant is primarily used as a short-term, rapid treatment for GPP. It’s often prescribed for 3 to 4 months but can sometimes be taken longer.
  • Methotrexate (Otrexup, Rasuvo, Trexall): This type of medication is slower-acting but may be prescribed before a stronger steroid treatment. Research suggests that methotrexate may be more appropriate for chronic GPP, but it should not be used in people who are pregnant, or those with diabetes or liver or kidney disease.
  • Oral retinoids: These are vitamin A derivatives that may help quickly reduce GPP symptoms. Examples include isotretinoin (Absorica, Myorisan, Zenatane) and acitretin (Soriatane). Oral retinoids are not recommended for people who are pregnant.
  • Prednisolone (Orapred, Prelone): This oral steroid may be prescribed to reduce inflammation in cases where other treatment options don’t work. Some research suggests that oral steroids may increase the risk of drug resistance in the long run. Other research indicates that people prescribed oral steroids to treat GPP may also have a higher mortality rate than those prescribed biologics or oral medications without biologics.

Topical treatments, like over-the-counter emollients and corticosteroid creams, are often considered first-line options for most types of psoriasis because they target skin symptoms without the side effects of oral or intravenous (IV) medications.

However, given the severity of GPP, topical medications may not be as effective as other treatments. In fact, topical treatments are typically not recommended for GPP flare-ups.

They may be recommended as maintenance therapy after flare-ups or combined with other treatments, such as oral drugs and biologics, to manage psoriasis-like symptoms.

While not usually the first choice for GPP treatment, phototherapy may be recommended as an add-on treatment for severe symptoms.

Also called “light therapy,” phototherapy can be an in-office or at-home treatment, and it’s also considered successful in treating plaque psoriasis. People prescribed this treatment for GPP usually receive three sessions per week.

A 2022 case report found that a combination of phototherapy with narrowband ultraviolet B rays and acitretin (Soriatane) was particularly successful in people experiencing acute GPP. These individuals had previously developed a resistance to adalimumab (Humira), another biologic.

Despite some reports of success with phototherapy, it’s important to keep in mind that this is not a primary treatment for severe GPP.

Like medications, phototherapy also has a range of risks and side effects, including dry skin and blistering. There may also be a risk of skin cancer, depending on the type of ultraviolet light used, per a 2022 review of research. Researchers did note research limitations, including a limited amount of research on this topic and variable reporting processes.

GPP is a rare but serious form of psoriasis. While no single therapy works for everyone, a healthcare professional may consider numerous treatments for this condition, including a combination of biologic, topical, and oral medications.

This type of psoriasis can cause severe inflammation throughout the body, which can lead to life threatening complications. It’s important to get treatment for GPP as soon as possible, whether you already have a diagnosis or if you suspect you have this condition.

Treating GPP will not only help decrease your symptoms, but it may also lower your risk of developing serious complications.

Consider talking with a dermatologist or other healthcare professional about all your GPP treatment options. You can also ask them about emerging therapies that are continuously being investigated for this condition.

If you don’t already have a dermatologist, you can use the American Academy of Dermatology Association’s “Find a Dermatologist” source to find one near you.