Phenotypic differences in clinical manifestations of generalized pustular psoriasis and severe plaque psoriasis in tropical Taiwan

• Main Authors: Yin-Cheng Chao (Author), Chih-Hung Lee (Author)
• Format: Book
• Published: Wolters Kluwer Medknow Publications, 2024-09-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 1027-8117; 2223-330X; 10.4103/ds.DS-D-24-00061
• Keywords: generalized pustular psoriasis; plaque psoriasis; Dermatology; RL1-803
• Source: Dermatologica Sinica, Vol 42, Iss 3, Pp 212-217 (2024)

Background: Generalized pustular psoriasis (GPP) is an uncommon variant of psoriasis. Clinical characteristics of GPP are limited due to its relatively low prevalence worldwide. Thus, the region-specific phenotypic differences between GPP and severe plaque psoriasis (SPP) remained not fully clarified. Objectives: This study aimed to compare the gender distribution, disease onset, clinical features, medical comorbidities, associated symptoms, laboratory findings, and potential precipitating factors of GPP and SPP in a single center in tropical Taiwan. Methods: A retrospective review was conducted for GPP and SPP in a tertiary medical center from 2003 to 2023. The GPP Area and Severity Index (GPPASI) and GPP Physician Global Assessment (GPPGA) score were used to measure the severity of GPP. Results: A total of 26 patients with GPP (mean age: 48.2 years) and 50 patients with SPP (defined as psoriasis area and severity index over 20 and undergoing biological agents more than 1 year, mean age: 41.3 years) were included in this study. Forty-six percentage of the GPP patients had a preceding history of psoriasis. While there was no gender or age predominance, patients with GPP tended to develop fever, hypertension, upper respiratory tract infection, leukocytosis, elevated C-reactive protein (CRP) levels, scalp involvement, be hospitalized and for a long time, along with allergy history of medications (diclofenac, ampicillin, and ceftriaxone), as compared to those with SPP. Hepatitis B virus and hepatitis C virus infections were less prevalent in GPP patients (with 15.4% and 3.8%, compared to 30.0% and 8.0% in SPP, respectively, although not statistically significant). The highest GPPASI and GPPGA scores occurred in young patients of GPP, but they are not associated with diseases of hypertension, hyperglycemia, or hyperlipidemia. Conclusion: Patients with GPP in Taiwan tended to have a higher hospitalization rate and longer mean hospitalization time along with increased occurrence of fever, leukocytosis, elevated CRP levels, and drug allergy. The younger patients of GPP tended to have higher GPPASI and GPPGA scores than the elder ones.