Generalized Pustular Psoriasis Linked to Higher Mortality Risk Than Plaque Psoriasis: Study

The findings, published in the Journal of Psoriasis and Psoriatic Arthritis by Dr. Alice B. Gottlieb from the Department of Dermatology, Icahn School of Medicine at Mount Sinai, and her team, add to the limited body of evidence on the mortality burden associated with GPP in the United States.

The study analyzed nationwide US claims data gathered between January 2016 and December 2019. The investigators compared all-cause mortality across several cohorts: patients with GPP only, those with both GPP and plaque psoriasis (PsO), patients with plaque PsO only, and the general population. Propensity score matching was used to adjust for baseline differences between the groups.

A total of 1,246 patients were identified in the GPP-only cohort, 1,384 in the GPP + PsO group, 2,630 in the combined All-GPP cohort, and 127,540 in the plaque-PsO-only group. For the general population comparison, 19.6 million individuals were included. The duration of follow-up ranged from just over three to nearly three and a half years (36.14 to 41.28 months).

The study revealed the following findings:

• Patients with GPP exhibited a significantly higher risk of death.
• At one-year follow-up, the All-GPP group had nearly a five-fold increased mortality risk compared to the general population (HR 4.93).
• When compared to patients with plaque psoriasis only, the All-GPP group had more than double the mortality risk at one year (HR 2.31).
• The elevated mortality risk for GPP patients remained consistent during longer-term follow-up.
• At maximum follow-up, mortality in the All-GPP cohort was nearly four times higher than in the general population (HR 3.98).
• Mortality in the All-GPP group was also 1.5 times higher than in the plaque psoriasis-only group at maximum follow-up (HR 1.49).

The authors emphasized that these findings highlight the serious clinical nature of GPP. Patients with GPP not only endure a severe and potentially life-threatening form of psoriasis but also face a long-term elevated mortality risk, even when compared to those with the more common plaque psoriasis.

These results, they note, highlight the urgent need for improved management strategies and greater clinical attention to the risks associated with GPP. Future studies are warranted to explore the underlying causes of increased mortality in this patient population and to guide interventions that could mitigate this risk.

Reference:

Gottlieb, A. B., Kwiatkowski, H. C., Semeco, J., Lakshminarasimhan, B., Strober, B., & Lebwohl, M. (2025). All-Cause Mortality is Higher in Generalized Pustular Psoriasis (GPP) than Plaque Psoriasis and the General Population: A US-Based Claims Analysis. Journal of Psoriasis and Psoriatic Arthritis®. https://doi.org/1344155