Dermatological diseases such as generalized pustular psoriasis (GPP) often result in considerable distress among patients due to their outward visibility. Such dermatological diseases burden the patient in two ways: the disease itself, which needs treating, and self-perception and self-esteem issues that can result in considerable psychiatric pathology. 

There is a dichotomy in medicine when it comes to illnesses that are visible vs those that are not immediately apparent to the naked eye. Oftentimes, clinicians find themselves in an awkward position, trying to convince patients with mostly hidden diseases (such as systemic lupus erythematosus) that their condition warrants serious, consistent care, whereas the opposite is true for diseases that are manifestly present and can be seen and noticed by all but are easily treated.  

A certain degree of consternation on the part of the patient may well translate to better treatment adherence and surveillance. However, all clinicians should recognize that dermatological diseases such as GPP can be a significant source of distress to patients and their caregivers if they perceive external stigmata of disease to be a hindrance to interacting with others or performing activities of daily living.

GPP vs Psoriasis Vulgaris 

To better understand the burden associated with GPP, Tarride and colleagues sought to characterize how Canadian patients view the disease compared with psoriasis vulgaris (PV). They published their findings in JAAD International. They accessed 2 databases from the Canadian Institute for Health Information to identify Canadians who had been seen at a healthcare facility for GPP or PV. Patients must be 18 years of age or over and been seen between April 1, 2010, and March 31, 2020. 

Read more about GPP etiology 

The research team identified 607 individuals with GPP and 24,828 individuals with PV. The prevalence rate for GPP was 2.77 per million individuals and was 113.13 per million individuals for PV. These statistics clearly indicate the considerable rarity of GPP. 

The main differences in comorbidities between patients of the two cohorts was depression (8.4% in the GPP cohort; 11.3% in the PV cohort) and psoriatic arthritis (4.3% in the GPP cohort; 2.2% in the PV cohort). The researchers reported that 10-year all-cause costs were substantially higher among patients in the GPP cohort. Over the same period, patients with GPP suffered from higher all-cause inpatient mortality compared with patients with PV (9.2% vs 7.3%). 

Health Burden of GPP 

“Although comparisons with other studies may be difficult due to differences in design, data availability, and health care settings, our results are aligned with the emerging literature on the burden of GPP,” Tarride et al wrote.

In other words, the prevalence and incidence rates reported were comparable to studies from other European countries, such as Sweden. The high costs of treating GPP have also been found to be true worldwide. Going a step further, the authors suggest that there may be additional hidden costs if physician billing and prescription drug databases were looked at in greater detail. 

The study by Tarride and colleagues primarily considered the economic burden of living with GPP; however, the emotional and psychosocial aspects of the disease were left unexplored. In The Journal of Dermatology, Hayama and colleagues conducted a study to assess how quality of life among patients with GPP could be improved in Japan. 

Their methodology differed considerably; instead of accessing administrative records, the researchers sent questionnaires to 668 hospitals and facilities that provided dermatological training. A separate questionnaire was sent to participating institutions to collect the data of patients who were diagnosed with GPP according to Japanese criteria. 

Overall, this research team collected 83 patient’s data from 33 institutions. Because the research team conducted a similar study between 2003 and 2007 (while this study was conducted from 2016 to 2019), they had a with which baseline to compare current results. They reported that patients in this study had better health, vitality, social functioning, and mental health compared with patients in the first study. 

Read more about GPP treatment 

“Taken together, although still impaired, substantial improvement of quality of life in GPP patients was demonstrated,” Hayama et al wrote. 

This improvement is welcome news and could be influenced by a multitude of factors, such as better patient education, speedier diagnoses, and improved therapeutics. Nevertheless, the quality of life scores for “role-physical” and “role-emotional” remained low, demonstrating that patients’ work and social life is still considerably impaired by the condition. 

These results support the theory that one of the biggest stings of a diagnosis of GPP is that it is clearly visible unless the lesions are covered up. Patients have time and again expressed a lack of confidence in work and social settings due to how they are viewed by others. In addition, patients with this disorder often contend with fatigue, muscle weakness, joint pain, and itching. These symptoms, depending on their severity, can substantially reduce quality of life, given that they can be rather relentless in their manifestations.

The silver lining here, according to the study by Hayama et al, is that advances in treatment have improved the quality of life of patients in recent years. Nevertheless, more needs to be done. Research into potentially game-changing biologics must continue. In addition, patients should be made fully aware of how this disease is currently diagnosed and treated and offered psychiatric assistance if necessary. 


Tarride JE, Prajapati VH, Lynde C, Blackhouse G. The burden associated with generalized pustular psoriasis: a Canadian population-based study of inpatient care, emergency departments, and hospital- or community-based outpatient clinicsJAAD Int. 2023;12:90-98. doi:10.1016/j.jdin.2023.03.012

Hayama K, Fujita H, Iwatsuki K, Terui T. Improved quality of life of patients with generalized pustular psoriasis in Japan: a cross-sectional surveyJ Dermatol. 2021;48(2):203-206. doi:10.1111/1346-8138.15657