Boni Elewski, MD, shares resources for patients with GPP, highlighting a team-based approach to meet the psychological and physical needs of the patient.
Raj Chovatiya, MD, PhD: You have obviously seen several GPP [generalized pustular psoriasis] patients through your career. I've seen them too, and I'm always curious, when it comes to thinking about resources or support that's available for people that want to learn more, whether it be from a patient side [or] provider side, what do you recommend, what's out there? Because I will say that we know that a comorbidity standpoint, GPP patients have a lot going on, anxiety, depression, all that is sort of real, too. And I like to think about, if I was in that position with this uncertainty of what's going on, I'd want to arm myself with as much information as possible, feel like I have a little more control over my circumstances. How have you found sort of educational tips and tricks out there for other providers?
Boni Elewski, MD: This is a team approach. So, we need the dermatologist who's the expert. The family needs to be involved in the disease. The patient needs to understand the disease and understand the triggers of the disease and when to seek help before they end up in the emergency department a mess. And the patient probably needs, in many cases, psychological help because they're under stress, they're worried about another flare. They may need pain management in addition. When the flares occur, pain is horrible. Patients have told me, "It feels like my skin is being peeled away from me." You don't think about it, but they're in really horrible pain. So, they may need pain management in addition to psychological services. It's a kind of a holistic approach and they need a good internist or primary care physician who understands this and can deal with all the complications that can occur with this condition. They may need dietetic consultation to see a dietician. I already mentioned pain management and psychology. We need to also educate intensivists to understand this disease, if someone gets to the hospital, what it is. It would be nice also if they could get some sort of band, like if you have diabetes, you wear an armband so patients know. They could say, "I have GPP," so they know when they get a flare what it is. That would be helpful. But the patient needs a team approach work strategy.
Raj Chovatiya, MD, PhD: I love that multimodal idea and it's exactly sort of what I think about across a lot of the inflammatory diseases we see, particularly this one where we know that the unpredictability and severity together can make for really sort of a terrible combination if really somebody isn't armed with the right tools out there. Educationally speaking, there's actually really good material available through the National Psoriasis Foundation online about GPP. I know I directed my patient there in addition to many of the other resources that we use as well. So, that's just another really helpful one. And I guess, maybe, the last question I have for you, then is any last minute pearls that you want to share in terms of management for GPP that we really haven't talked about today that you really think all dermatologists out there really need to be thinking about?
Boni Elewski, MD: In general, we want to do what we can for our psoriasis patients to prevent them from ending up in the GPP bucket. So, we don't want to use antimalarials. We tell them to try to avoid steroids. And we try to avoid other drugs that might trigger flares such as beta blockers. But once you know a patient has GPP, we need to have a good treatment for them so they don't flare and a long-term strategy to keep flares from occurring. Now, my lady, we mentioned the strategy is to keep her on guselkumab, and hopefully she's clear, and I talk to her every month and she's clear. She's quite worried that she's going to have a flare again, but she hasn't. So, that's basically my plan.
Raj Chovatiya, MD, PhD: I'd say that my 1 pearl out there for the dermatologists that are tuning in, not all GPP looks exactly the same. I think that's what I highlighted in my case, that you may remember what you learned from your textbook and residency training about this person covered in lakes of pus, as Boni so nicely put it, but remember, there can be sort of a lot of variations the same way that many of our patients with conventional plaque psoriasis, atopic dermatitis or HS [hidradenitis suppurativa]; don't read the textbook. Not all GPP patients are reading the textbook, too, and so, just keep an open mind when thinking about what you see, what you hear, and the longitudinal course of disease to really make the right selection when it comes to treatment. And the nice part is that we have actual targeted now, and so we really can treat somebody if you're very, very confident of the diagnosis.
Boni Elewski, MD: Good point.
Raj Chovatiya, MD, PhD: On that, a big thank you from myself, Raj Chovatiya, and on behalf of Boni Elewski, too, thank so much for tuning in.
Transcript edited for clarity.