Asia-Pacific consensus recommendations on the management of generalized pustular psoriasis.
Journal
The Journal of dermatology
ISSN
1346-8138
Date Issued
2024-10-10
Author(s)
Choon, Siew Eng
Foley, Peter Anthony
Asawanonda, Pravit
Fujita, Hideki
Jo, Seong-Jin
Shi, Yu-Ling
Theng, Colin
Affandi, Azura Mohd
Bang, Chul Hwan
Frez, Maria Lorna
Huei, Huang Yu
Le Huu, Doanh
Kim, Tae-Gyun
Morita, Akimichi
Oon, Hazel H
Fernández-Peñas, Pablo
Rajatanavin, Natta
Robinson, Suganthy
Selvarajah, Latha
Abstract
Generalized pustular psoriasis (GPP) is a rare, chronic, heterogeneous, and potentially life-threatening disease characterized by primary, sterile, and macroscopically visible pustules with or without systemic symptoms. There are ethnic differences in the genetic mutations associated with GPP that might affect the clinical manifestations and treatment responses. Currently, there is limited evidence from the patient population in the Asia-Pacific (APAC) region, resulting in a general paucity of information on the effective management of patients with GPP in this region. This modified Delphi panel study aimed to identify current evidence and gain advanced insights to facilitate the development of a regionally tailored APAC consensus on the management of GPP. A systematic literature review (SLR) was conducted to identify published literature and develop consensus statements on (i) definition and clinical course, (ii) diagnosis of GPP, (iii) treatment outcomes, goals, and monitoring measures, and (iv) optimal management strategies and clinical practices. Statements were rated by a panel of dermatologists in two rounds, with the threshold for consensus at ≥80% agreement. Twenty experts from the APAC region reached consensus on 106 statements that were developed based on the SLR and experts' collective expertise. The experts agreed that GPP is a rare, severe, and potentially life-threatening condition that is distinct from plaque psoriasis. This consensus emphasized the importance of a tailored treatment strategy taking into account the GPP flare severity and each patient's unique clinical circumstances. The experts reached consensus on the severity classification of GPP flares and recommended first-line and maintenance treatment options for adult GPP, childhood GPP, and GPP in pregnancy. These consensus outcomes have been synthesized into treatment algorithms to guide dermatologists in the APAC region in their clinical decision-making processes.
Subjects
Asia‐Pacific
Delphi panel
consensus
generalized pustular psoriasis
management
Publisher
Wiley
Type
journal article