A patient with generalized pustular psoriasis (GPP) may experience clinical flares during the course of the disease.
Risk factors for flares:
(1) higher comorbidity burden
Triggers for flares include:
(1) withdrawal of treatment (corticosteroids, other)
(2) pregnancy
(3) stress
(4) infection
(5) severe hypocalcemia
(6) menstruation
Clinical features of a flare:
(1) sudden and widespread formation of sterile pustules with erythema
(2) pustules may coalesce
(3) fever
(4) chills
(5) malaise
(6) fatigue
(7) anorexia
(8) nausea
(9) severe pain
The patient will show an increase in the Generalized Pustular Psoriasis Physician Global Assessment (GPPGA).
Laboratory findings:
(1) elevated serum CRP concentration
(2) peripheral neutrophilia
A flare can be severe and require emergency or acute care if there is:
(1) heart failure
(2) shock
(3) renal failure
(4) sepsis
