Generalized Pustular Psoriasis Imposes Greater Burden Than Psoriasis Vulgaris

Individuals with generalized pustular psoriasis (GPP) may maintain a higher burden and more impaired quality of life (QoL) than those suffering from psoriasis vulgaris, according to new findings ascertained through the newly developed Short Form (SF)-36 evaluation.1

The use of this modified evaluation method, along with the findings resulting from the method, were authored in part by Shinichi Imafuku, from the department of dermatology at the Fukuoka University School of Medicine in Japan. Imafuku et al. noted that QoL among individuals with psoriasis was evaluated in their research via a standardized and adjusted version of SF-36 known as SF-36v216.2

“This study aimed to determine whether the disease burden and QOL between patients in the two disease groups were different,” Imafuku and colleagues wrote. “Patients enrolled in the [Western Japan Psoriasis Registry] were surveyed using an original questionnaire developed to assess disease-related experiences and burdens.”1

Disease-Related Burden for Generalized Pustular Psoriasis versus Psoriasis Vulgaris

The investigators assessed data on patients with both inflammatory conditions using the Western Japan Psoriasis Registry (WJPR), established in 2019 as the first clinician-led, prospective observational registry used in Japan for patients suffering with psoriasis. Their main objective in using the registry was to enhance awareness of the disease and develop optimal management strategies for those with the skin disease.

Differences between GPP and psoriasis vulgaris in terms of experiences, QoL, and overall burden were assessed. The developed a working hypotheses prior to the analysis indicating that compared to those with psoriasis vulgaris, individuals with GPP would experience greater dissatisfaction with treatment, would have lower awareness of the condition at the time of their diagnosis, would be more likely to be given alternative diagnoses prior to confirmation, would have heightened anxiety about relapsing, and report lower SF-36v2 scores.

The investigative team evaluated a variety of patient-reported outcomes, including Dermatology Life Quality Index (DLQI), the SF-36v2, the Patient’s General Assessment (PaGA), and the itch Numerical Rating Scale (NRS). Enrollment of patients with the conditions was conducted and data collection was carried out from October 2022 - January 2023.

The team determined eligibility for participation in the analyis based on a set of criteria: those involved would have had been diagnosed with either GPP or psoriasis vulgaris by their attending physician, already registered in the WJPR, and would have then agreed to participate in the evaluation.

Overall, there were a total of 97 individuals with GPP and 1,065 individuals with psoriasis vulgaris included in the investigators' assessment. In their findings, the team concluded that subjects with GPP, compared to psoriasis vulgaris, had an earlier onset of their condition, were more frequently female, and had lower rates of alcohol intake and smoking. They also found that GPP patients more frequently used biologic medications.

Reports of blisters, sores, pain in their skin, and systemic symptoms were noted among those reporting GPP at a higher frequency than subjects with psoriasis vulgaris. Additionally, it was noted that those with GPP had greater prevalence of joint pain and fatigue.

However, the investigative team did highlight that treatment satisfaction had no statistically significant distinctions between the 2 cohorts.

“In conclusion, the questionnaire and SF-36 results obtained from patients with GPP and [psoriasis vulgaris] indicate that patients with GPP have a greater disease burden and impaired QOL than patients with [psoriasis vulgaris],” they wrote. “The treatment strategies for patients with GPP should consider these factors.”1

References

1. Imafuku S, Satoh A, Arima H, Tsuruta N, Iwasaki R, Kimura H. Quality of life of patients with pustular psoriasis is inferior to that of patients with plaque psoriasis in Japan: A multicenter study with questionnaires, the short Form-36, and other patient-reported outcomes. J Dermatol. 2025; 00: 1–13. https://doi.org/10.1111/1346-8138.17629.

2. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992; 30: 473–483.