Recent Advances in Generalized Pustular Psoriasis

Written by Jodi Helmer
Medically Reviewed by Neha Pathak, MD on February 11, 2026
5 min read

Generalized pustular psoriasis (GPP) is not just a skin condition. GPP flares cause pus-filled bumps called pustules to cover large areas of your body, which can lead to intense itching, headache, nausea, fatigue, joint pain, muscle weakness, and fever. In addition to feeling incredibly unwell, you could face life-threatening complications, like a sudden drop in blood pressure.

“A lot of times when patients get this type of flare-up … they end up in the emergency room,” says JiaDe (Jeff) Yu, MD, chair of dermatology at VCU Health in Richmond, Virginia. “GPP patients are systemically unwell.”

 

 

Despite the severity, GPP is often misunderstood. One reason is that GPP is a rare disease, affecting just 1 out of every 10,000 people in the United States. While more than half of those with GPP also have plaque psoriasis, GPP is a distinct disease, not a severe form of plaque psoriasis. 

“We know that, like psoriasis, GPP represents an overactivation of the immune system,” Yu says. “Historically, we used to treat it with anything that suppressed the immune system.”

Your pus-filled bumps can appear suddenly and spread quickly. Flares can last for weeks before your skin clears up and the disease goes into temporary remission. Flares require immediate medical attention. Without treatment, GPP can be life-threatening.

Yu notes that the most common medications used to treat GPP in the past were steroid medications, including:

  • Cyclosporine
  • Methotrexate
  • Prednisone

The same medications are often used to treat autoimmune diseases like lupus, rheumatoid arthritis, and atopic dermatitis because they shut down the immune system, which resolves GPP flares, according to Yu. Research shows that steroid medications have been prescribed to many patients with GPP – more than any other medications – but the results have been poor. Yu also notes that many older medications are linked to higher risk of infections, kidney problems, and blood pressure issues.

“These are really old drugs, but they are still effective to a certain degree,” Yu says. “We might be looking at a 40% to 50% response rate.” 

Biologic medications used to treat plaque psoriasis can also treat GPP. These medicines, including monoclonal antibodies, are made by living cells. The use of these medications, which are given via injection either under the skin (subcutaneous) or in a vein (intravenous), is increasing. Biologics are often prescribed along with other medications, like topical steroids, to better control symptoms. While biologics can be effective, it can sometimes be difficult for patients to access them quickly enough for the needed symptom relief. 

“I can prescribe a patient [a biologic], but I’m not sure it’s going to get covered by insurance – and you’re certainly not going to be able to go to [a pharmacy] right after an appointment to pick up the drug,” Yu says. “GPP patients are sicker than normal plaque psoriasis patients who could wait a week or two before getting medications … we can’t do that with GPP patients.”

It’s one of the reasons that doctors continue to prescribe steroid medications, he adds.

The biggest advance in GPP treatment came with the discovery of interleukin-36 (IL-36), which acts as a key signal in the inflammatory immune pathway that drives the disease. When IL-36 becomes overactive, your immune system responds with inflammation and the condition’s signature pustules. The discovery has led to a new targeted medication to treat GPP.

Spesolimab-sbzo is the first medication specifically approved by the FDA to treat GPP in adults and children ages 12 and up. The injection medication, which was approved in 2022, blocks the activation of IL-36 to reduce GPP flares. In clinical trials, more than half of the study’s participants who received spesolimab-sbzo had no visible pustules after one week.

“Having the right treatment that is available, ready for the patient to go when they need it is extremely important,” Yu says. “[It’s] going to shut down their fever, decrease their pustular count, [and] get them better very, very quickly.”

Yu also notes that the IL-36 inhibitor has a good safety profile compared to other drugs used to treat GPP.

 

Research to further expand GPP treatment options is underway. Yu points to a small number of clinical trials that are exploring the potential to repurpose existing drugs to treat GPP. In particular, research is focusing on IL-17 and IL-23 inhibitors that are approved to treat moderate-to-severe plaque psoriasis. The medications used to treat GPP, including those being studied for possible future use, are not a cure for the disease. Instead, Yu explains, the medications are meant to control flares. You’ll likely need to continue treatment to keep your symptoms from returning.

“Unfortunately for a lot of these immune system driven diseases, unless you are curing the specific defect in the immune system, which we are currently not yet able to do, there is a possibility they will need these drugs ongoing for long-term periods,” he says.

If you live with GPP, Yu stresses that effective, targeted treatments exist and are a good alternative to older medications that might be slower and less predictable or that come with more side effects. It’s important to recognize the symptoms of a flare and seek care from a board-certified dermatologist to get the right treatment.

“There are very effective treatment therapies out there,” says Yu. “I don’t think [you] should be relying on just the older medications. … You should probably consider going on one of these more targeted, safer, and more effective therapies that now exist.”