Clinical characteristics of Indian patients with generalised pustular psoriasis: A multicentre retrospective analysis

Background Generalised pustular psoriasis (GPP) is a chronic, systemic inflammatory disease with a heterogeneous and unpredictable clinical course. Data on patient characteristics, flare outcomes, and GPP management in India are lacking. Objective To describe the demographic and clinical characteristics of patients with GPP and various treatments prescribed to manage GPP across India. Methods This multicentre, retrospective analysis included patients diagnosed with GPP who experienced at least one flare between December 2017 and November 2022. Data related to demographics and details of the most recent GPP flare, including triggers, symptoms, laboratory parameters, severity, treatments and outcome were collected. Results Records of 54 patients from 11 dermatology centres were included. Median (IQR) age was 46 (17.8) years. Females (59.3%) outnumbered males. Plaque psoriasis was the commonest comorbidity in 34 (63.0%) patients. Triggers for the most recent flare were identified in 30 (55.6%) patients, with stress being the most common in 13 (24.1%) patients. The three main symptoms, apart from pustules, included pain in 44 (81.5%), pruritus in 41 (75.9%), and burning sensation in 39 (72.2%) patients. Elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were noted in 15 of 16 (93.8%) and 20 of 31 (64.5%) evaluated patients, respectively. Data on flare severity were available for 51 (94.4%) patients. The severity of pustulation, erythema, and scaling was ‘moderate’ in 29 (56.9%), 23 (45.1%), and 30 (58.8%) patients, respectively; and ‘severe/very severe’ in 16 (31.3%), 20 (39.2%), and 9 (17.6%) patients, respectively. Twenty-eight (51.9%) patients received cyclosporine. Methotrexate was used for the prevention of GPP flares in 23 (42.6%) patients. The most recent flare led to hospitalisation in 40 (74.1%) patients with a median (IQR) duration of hospital stay of 9.5 (10.0) days. Eighteen of the 41 (43.9%) evaluated patients either required 3 5 weeks for pustular clearance or did not achieve pustular clearance. Twenty-eight of 45 (62.2%) evaluated patients did not achieve complete skin clearance. Median (IQR) time for clearance of pustules and skin clearance were 4 (2.5) weeks and 6 (4) weeks, respectively. Limitation Retrospective design and subjective assessment by treating physicians. Conclusion The study highlights the current unmet needs of Indian patients with GPP. Most patients in this study required prolonged hospitalisation. With the currently used therapies, pustular and skin symptom resolution took a median of 4 and 6 weeks, respectively. Moreover, many patients did not achieve complete skin or pustular clearance.