TOPLINE

Generalised pustular psoriasis (GPP) prevalence in England increased 56% between 2008 and 2022, while patients with GPP had a more than threefold higher risk for all-cause mortality than people without GPP.

METHODOLOGY

• Researchers conducted a population-based cohort study using primary care records from the Clinical Practice Research Datalink linked to hospital admissions, death registrations, area-level deprivation, and ethnicity data in England from 2008 to 2022.
• The cohort included 25.8 million people, of whom 991 had GPP; the mean age at onset was 51.4 years, and 63% were female individuals, 86% were White individuals, 10% were Asian individuals, and 3% were individuals from Black, Mixed, or Other ethnic groups.
• Researchers calculated annual prevalence and incidence rates and matched patients with incident GPP with up to 10 individuals without GPP.
• Mortality risks were compared using flexible parametric survival models and reported as adjusted hazard ratios (aHRs), and years of life lost were estimated using abridged life tables.

TAKEAWAY

• Prevalence increased from 20.9 to 32.5 per million and was higher among women, older adults, and, for most of the period, Asian people; mean age at onset was 36.5 years among Asian patients vs 53.6 years among White patients (P < .001).
• Incidence held steady through 2016 and then climbed from 2017, reaching 4.9 per million person-years in 2022.
• Patients with GPP had a more than threefold higher risk for all-cause mortality than matched people without GPP (aHR, 3.19; 95% CI, 2.58-3.91). The highest excess risk was observed for sepsis (aHR, 9.76; 95% CI, 4.92-19.35).
• The shortfall in life expectancy was largest when GPP was diagnosed at younger ages; at 50 years of age, estimated life expectancy was 15 years shorter for male patients with GPP than for male individuals without GPP and 14 years shorter for female patients with GPP than for female individuals without GPP.

IN PRACTICE

"Despite declining mortality, it remains higher in patients with GPP than the general population and other psoriasis phenotypes, highlighting the ongoing clinical burden of GPP and importance of managing flares and comorbidities effectively," the authors wrote.

SOURCE

The study was led by Alison K. Wright, University of Manchester, Manchester, England. It was published online on September 21, 2026, in British Journal of Dermatology.

LIMITATIONS

The study was limited by possible diagnostic misclassification, particularly among people with skin of colour, and lack of formal validation of the GPP diagnostic code. Broad ethnicity categories and unmeasured confounding may have affected the findings. Life expectancy estimates were less precise at younger ages, and hospital-prescribed medication data were unavailable, precluding the assessment of the effect of biologic treatment; spesolimab was approved after the study period.

DISCLOSURES

The study was funded by the Psoriasis Association. Two authors reported receiving research grants or honoraria from pharmaceutical companies, including Boehringer Ingelheim, Bristol Myers Squibb, and Janssen.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.