Raj Chovatiya, MD, PhD: Reaction to Updated Guidelines for Generalized Pustular Psoriasis

The Medical Board of the National Psoriasis Foundation recently provided an updated consensus statement designed to provide standardized guidance on management of generalized pustular psoriasis (GPP).

During an interview with HCPLive, Raj Chovatiya, MD, PhD, assistant professor of dermatology at the Feinberg School of Medicine at Northwestern University, reacted to the new guidelines and expressed his thoughts on their wider implications.

“GPP is another one of those (diseases) that we really didn't talk about all that much in the last handful of years,” Chovatiya said. “And since we've really understood its pathogenesis and have an FDA-approved treatment for this disease in the US, it's really changed our perspective and we’re trying to ask some of the bigger and more meaningful questions.”

Chovatiya highlighted the fact that GPP is distinct from conventional plaque psoriasis, as it is rare and can be a serious, even life-threatening immune mediated skin condition. He then went into the consensus statement updates themselves.

“I can even go through it, as it’s a pretty short piece,” Chovatiya explained. “...So everybody can kind of think about this as it relates to GPP. One of the statements that was generally in consensus with all the experts in this piece was the fact that GPP is life-threatening. And we have to treat it as quickly as possible. I think that inherently, based on everything I just mentioned about the condition, it makes sense, given the fact that you can have some really unfortunate outcomes and individuals who aren't managed correctly.”

Chovatiya added that the other consensus statement additions were based around diagnosis.

“There was high agreement around the idea that you really shouldn't be diagnosing this disease based on clinical features,” Chovatiya said. “Of course, clinical features in generalized pustular psoriasis, unsurprisingly, are really recurrent, disseminated, sterile, often monomorphic pustules that we think about in this confluent background of erythema. There can also be sort of laboratory abnormalities that are often related to inflammation as well as sort of systemic symptoms too.”

He mentioned another one of the additional statements on GPP.

“(Something) that's important for us to think about is the importance of skin biopsy, and the idea that skin biopsy may not actually be required for this disease just because there's nonspecific histologic features,” Chovatiya said. “I think that is one where we can oftentimes cause a little bit of controversy because we tend to think so biopsy-forward in dermatology, especially if there are serious conditions, but just given how pressing it is for us to make this diagnosis and to administer treatment, you can really diagnose the disease quite well from just clinical signs.”

To learn more about Chovatiya’s summarization of the updates, as well as his views on them, view the full interview above.

The quotes used here were edited for the purposes of clarity.