N 4 (195) 2025. P. 21–26

CLINICAL AND DIAGNOSTIC FEATURES OF GENERALIZED FORMS OF PUSTULAR PSORIASIS

M. E. Zapolskiy, T. V. Chaban, I. V. Svystunov, L. M. Tymofieieva, D. M. Zapolska

Odesa National Medical University, Odesa, Ukraine
Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine

DOI 10.32782/2226-2008-2025-4-3

Generalized pustular psoriasis (GPP, von Zumbusch disease) is a rare auto inflammatory disease that belongs to the neutrophilic dermatoses; the most severe form of psoriatic disease, which threatens the lives of patients and requires intensive therapy from the first hours of the disease. The mortality rate in case of inadequate therapy reaches 2–4%. If plaque forms of psoriasis do not pose diagnostic difficulties, pustular forms of psoriasis are often mistaken for eczema, bullous toxidermia, herpes, Andrews’ pustular bacterioides, subcorneal pustulosis, etc.

The research aims to study the clinical features course of various forms of pustular psoriasis in patients depending on the provoking factors. Materials and methods. Under our observation for 5 years, there were 57 patients with pustular psoriasis (with limited forms of pustular psoriasis – 34, with widespread – 23), who were treated at the Department of Dermatology and Venereology of Odesa Regional Clinical Hospital and at the multidisciplinary medical center “Renaissance Medical”. The diagnosis of pustular forms of psoriasis was established on the

basis of anamnesis data, clinical manifestations of the disease, laboratory tests, using the ICD-10 classification.

Results. Analysis of 57 cases of pustular forms of psoriasis: limited, widespread, generalized (von Zumbusch disease), juvenile pustular psoriasis, Acrodermatitis continua of Hallopeau, Barber’s palmoplantar pustulosis allowed us to identify a set of clinical and diagnostic criteria and distinguish GPP, from dermatoses that mimic it, make a timely diagnosis, and prescribe adequate therapy. This is especially important considering that morphological changes in GPP, dermatoscopic signs do not have sufficient specifics and cannot be used in differential diagnostic screening.

Keywords: generalized pustular psoriasis, clinical and diagnostic criteria.

REFERENCES

  1. Fujita H, Gooderham M, Romiti R. Diagnosis of generalized pustular psoriasis. Am J Clin Dermatol. 2022; 23(Suppl 1): 31–38. doi: 10.1007/s40257-021-00652-1.
  2. 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.
  3. Goyal PK, Mohammed TO, Mahmoud A, Zaidi AJ, Nguyen CV. COVID-19 infection leading to acute pustular dermatoses. Arch Dermatol Res. Published Online November 1. 2022; 1–13. doi: 10.1007/s00403-022-02450-z.
  4. Hoegler KM, John AM, Handler MZ, Schwartz RA. Generalized pustular psoriasis: a review and update on treatment. J EurAcad Dermatol Venereol. 2018; 32(10): 1645–1651. doi: 10.1111/jdv.14949.
  5. Kara Polat A, Alpsoy E, Kalkan G, et al. Sociodemographic, clinical, laboratory, treatment and prognostic characteristics of 156 generalized pustular psoriasis patients in Turkey: a multicentre case series. J EurAcad Dermatol Venereol. 2022; 36(8): 1256–1265. doi: 10.1111/jdv.18103
  6. Ly K, Beck KM, Smith MP, Thibodeaux Q, Bhutani T. Diagnosis and screening of patients with generalized pustular psoriasis. Psoriasis (Auckl). 2019; 9: 37–42. Published 2019 Jun 20. doi: 10.2147/PTT.S181808.
  7. Mahil SK, Catapano M, Di Meglio P, et al. An analysis of IL-36 signature genes and individuals with IL1RL2 knockout mutations validates IL-36 as a psoriasis therapeutic target [published correction appears in Sci Transl Med. 2017 Dec 13;9(420)]. Sci Transl Med. 2017; 9(411): eaan2514. doi: 10.1126/scitranslmed.aan2514.
  8. Prinz JC, Choon SE, Griffiths EM, et al. Prevalence, comorbidities and mortality of generalized pustular psoriasis: A literature review. J EurAcad Dermatol Venereol. 2023; 37(2): 256–273. doi: 10.1111/jdv.18720.
  9. Zhou J, Luo Q, Cheng Y, Wen X, Liu J. An update on genetic basis of generalized pustular psoriasis (review). Int J Mol Med. 2021; 47(6): 118. doi: 10.3892/ijmm.2021.4951.
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