GPP vs PPP — SCE Dermatology MCQ
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Correct answer: D — GPP is an acute/subacute life-threatening condition with widespread sterile pustules on erythematous skin with systemic symptoms; PPP is chronic localised sterile pustules confined to palms and soles — they are now considered separate diseases with different genetic drivers
The correct answer is D, GPP is an acute/subacute life-threatening condition with widespread sterile pustules on erythematous skin with systemic symptoms, while PPP is chronic localised sterile pustules confined to palms and soles, and they are now considered separate diseases with different genetic drivers. Generalised pustular psoriasis (GPP) presents with rapid widespread sterile pustules on erythematous skin, fever and raised inflammatory markers, classically precipitated by abrupt steroid withdrawal, as in this patient. It is strongly linked to loss of function IL36RN mutations driving unopposed IL-36 signalling, underpinning the licensing of spesolimab (an IL-36 receptor antagonist) specifically for GPP flares. Palmoplantar pustulosis (PPP) is a chronic, relapsing condition confined to palms and soles, strongly associated with smoking, with a far less consistent IL36RN association. Current NICE and BAD guidance treats GPP and PPP as separate entities rather than a single spectrum, reflecting differing tempo, systemic risk, triggers and genetics.
Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/skin-conditions