Dr. Lebwohl: Don't Delay GPP Treatment for TB Testing or Skin Biopsy
Generalized pustular psoriasis (GPP) treatment should not be delayed while waiting for a tuberculosis screening, according to Mark Lebwohl, MD.
Speaking at the Winter Clinical Hawaii 2025 meeting in Waikoloa Village, Hawaii, Dr. Lebwohl recommended initiating spesolimab therapy immediately upon suspicion of GPP.
“It is a miraculous drug,” Dr. Lebwohl said.
The in-hospital mortality rate of patients with GPP is lower for those who receive treatment with biologics (1%) versus treatment with corticosteroids (9.1%) or oral agents alone (3.7%).1
“It can be a deadly disease,” Dr. Lebwohl said. “Don’t wait for a TB test. You can [still] get your TB test. The average time for TB to develop in other biologics is months.”
Skin biopsies, meanwhile, are not even necessary, Dr. Lebwohl said, citing a consensus statement published last year in the Journal of the American Academy of Dermatology.2
“This is a pretty obvious diagnosis,” he said. “Patients with AGEP, which is the most commonly misdiagnosed condition for GPP, are not sick. That condition very superficial. … It simply goes away by itself with no intervention often.”
- Hackley M, Thampy D, et al. Increased risk of severe generalized pustular psoriasis due to tuberculosis screening delay for spesolimab initiation. J Am Acad Dermatol. 2024;90(2):408-410. doi: 10.1016/j.jaad.2023.09.078. Epub 2023 Oct 10.
- Armstrong AW, Elston CA, et al. Generalized pustular psoriasis: A consensus statement from the National Psoriasis Foundation. J Am Acad Dermatol. 2024;90(4):727-730. doi: 10.1016/j.jaad.2023.09.080. Epub 2023 Oct 13.