Global Delphi consensus on treatment goals for generalised pustular psoriasis
Authors: Jonathan N Barker, Emmylou Casanova, Siew Eng Choon, Peter Foley, Hideki Fujita, César Gonzalez, Melinda Gooderham, Slaheddine Marrakchi, Luís Puig, Ricardo Romiti, Diamant Thaçi, Min Zheng, Bruce Strober, Gabriel Magariños, Adam Reich, Juliana Nakano, Xinghua Gao, Furen Zhang, Mahira El Sayed, Julia Welzel, Paolo Gisondi, Yuzlina Binti Che Yaacob, Francesca Prignano, Yayoi Tada, Seong Jin Jo, Peter van der Kerkhof, Emmylou Casanova, Raquel Rivera, Marcus Schmitt-Egenolf, Tsen-Fang Tsai, Emel Bulbul Baskan, David Burden, Arash Mostaghimi, Dale Reisner, Kilian Eyerich, Alexandros Stratigos, Lev Pavlovsky, Delfina Guadalupe Villanueva Quintero, Shinichi Imafuku, Jennifer Becker, Azura Affandi, Carolina Cortés, Jose Manuel Carrascosa, Marni Wiseman, Manuelle-Anne Viguier, Tina Bhutani
Journal: British Journal of Dermatology (2025)

Abstract Background Generalised pustular psoriasis (GPP) is a chronic, systemic, neutrophilic inflammatory disease. A previous Delphi panel established areas of consensus on GPP, although patient perspectives were not included, and aspects of treatment goals remain unclear. Objectives To identify and achieve consensus on refined, specific treatment goals for GPP treatment via a Delphi panel with patient participation. Methods Statements were generated based on a systematic literature review and revised by a Steering Committee. Statements were categorised into overarching principles, short-term treatment goals and long-term treatment goals. A global panel of 30 dermatologists and three patient representatives voted in agreement or disagreement with each statement. Consensus was defined as ≥80% approval by panellists. Results Consensus was reached in the first round of voting and ≥90% agreement was reached for 23/26 statements. In summary, GPP requires a timely, tailored treatment plan, co-developed by patients and physicians, that involves a multidisciplinary approach and addresses the complexity, heterogeneity and chronicity of the disease. Short-term treatment goals should include pustule clearance within 7 days and prevention of pustule recurrence, reduction of cutaneous symptom burden (≥ −4 points on the Itch and Skin Pain Numeric Rating Scale), improvement in systemic symptoms (e.g. resolution of fever within 3 days of treatment initiation and reduced fatigue), prevention of life-threatening complications, and progressive improvement of inflammatory biomarkers. In patients with comorbid psoriatic diseases, treatment decisions should prioritise GPP. Long-term treatment goals should include minimising disease activity through flare prevention and symptom control between flares, sustained disease control, management of comorbidities and improvement in quality of life (QoL). Small differences in perception between patients and physicians regarding the importance of certain treatment goals, e.g. avoiding hair and/or nail loss to improve QoL, reflect the complexity of assessing treatment goals and emphasise the need for a patient-centred approach. Conclusions In the first global Delphi panel in GPP to include patient perspectives, consensus between dermatologists and patients was achieved on overarching principles of treatment, short-term and long-term treatment goals for GPP. These findings provide valuable insights for developing guidelines that consider the perspectives of both patients and physicians in the treatment of GPP.