Differentiating Generalized Pustular Psoriasis (GPP) from Other Skin Conditions

Opinion
Video

Dr Scott Boswell highlights how he differentiates between generalized pustular psoriasis (GPP) and other dermatologic conditions.

This is a video synopsis/summary of a panel discussion involving Tina Bhutani, MD; J. Scott Boswell, MD; and Kanya Oul, RN.

Generalized pustular psoriasis (GPP) presents in 2 main forms: with plaque psoriasis and without. Patients with plaque psoriasis can develop pustular flares, while others experience flare-ups without having plaque psoriasis in between. The latter group poses a diagnostic challenge because they may not exhibit symptoms between flare-ups, making it difficult to differentiate from other skin conditions like (acute generalized exanthematous pustulosis) AGEP, a drug eruption characterized by monomorphic sterile pustules following medication intake.

Dermatologists use biopsies to distinguish between GPP and AGEP. GPP biopsies reveal subcorneal pustules and necrotic keratinocytes, whereas AGEP biopsies show spongiosis and eosinophils. Additionally, infections like bullous impetigo and SNED can mimic GPP, but they typically lack systemic symptoms and are managed as outpatient cases.

SNED, or Wilkinson disease, particularly affects elderly females, presenting with annular pustules in body folds without systemic symptoms. These distinctions are crucial for appropriate management and treatment decisions. Biopsies play a key role in confirming the diagnosis and guiding dermatologists in distinguishing between various postural skin diseases.

Video synopsis is AI-generated and reviewed by HCPLive editorial staff.

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