Global Delphi consensus on treatment goals for generalized pustular psoriasis
Journal
British Journal of Dermatology
Journal Volume
192
Journal Issue
4
Start Page
706-716
ISSN
0007-0963
1365-2133
Date Issued
2025-01-23
Author(s)
Barker, Jonathan N
Casanova, Emmylou
Choon, Siew Eng
Foley, Peter
Fujita, Hideki
Gonzalez, César
Gooderham, Melinda
Marrakchi, Slaheddine
Puig, Luís
Romiti, Ricardo
Thaçi, Diamant
Zheng, Min
Strober, Bruce
Magariños, Gabriel
Reich, Adam
Nakano, Juliana
Gao, Xinghua
Zhang, Furen
El Sayed, Mahira
Welzel, Julia
Gisondi, Paolo
Che Yaacob, Yuzlina Binti
Prignano, Francesca
Tada, Yayoi
Jin Jo, Seong
van der Kerkhof, Peter
Casanova, Emmylou
Rivera, Raquel
Schmitt-Egenolf, Marcus
et al.
Abstract
Background: Generalized pustular psoriasis (GPP) is a chronic, systemic, neutrophilic inflammatory disease. A previous Delphi panel established areas of consensus on GPP, although patient perspectives were not included and aspects of treatment goals remained unclear.
Objectives: To identify and achieve consensus on refined, specific treatment goals for GPP treatment via a Delphi panel with patient participation.
Methods: Statements were generated based on a systematic literature review and revised by a Steering Committee. Statements were categorized into overarching principles, and short- and long-term treatment goals. A global panel of 30 dermatologists and 3 patient representatives voted in agreement or disagreement with each statement. Consensus was defined as ≥ 80% approval by the panellists.
Results: Consensus was reached in the first round of voting and ≥ 90% agreement was reached for 23 of 26 statements. In summary, GPP requires a timely, tailored treatment plan, co-developed by patients and physicians, that involves a multidisciplinary approach and addresses the complexity, heterogeneity and chronicity of the disease. Short-term treatment goals should include pustule clearance within 7 days and prevention of pustule recurrence, reduction of cutaneous symptom burden (-4 or more points on the Itch and Skin Pain Numeric Rating Scale), improvement in systemic symptoms (e.g. resolution of fever within 3 days of treatment initiation and reduced fatigue), prevention of life-threatening complications and progressive improvement of inflammatory biomarkers. In patients with comorbid psoriatic diseases, treatment decisions should prioritize GPP. Long-term treatment goals should include minimizing disease activity through flare prevention and symptom control between flares, sustained disease control, management of comorbidities and improvement in quality of life (QoL). Small differences in perception between patients and physicians regarding the importance of certain treatment goals (e.g. avoiding hair and/or nail loss to improve QoL), reflect the complexity of assessing treatment goals and emphasize the need for a patient-centred approach.
Conclusions: In the first global Delphi panel in GPP to include patient perspectives, consensus between dermatologists and patients was achieved on overarching principles of treatment, and short- and long-term treatment goals for GPP. These findings provide valuable insights for developing guidelines that consider the perspectives of patients and physicians in the treatment of GPP.
Publisher
Oxford University Press (OUP)
Type
journal article