{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T22:17:13Z","timestamp":1790979433333,"version":"4.1.0"},"reference-count":36,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2013,8,22]],"date-time":"2013-08-22T00:00:00Z","timestamp":1377129600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Dermatology"],"published-print":{"date-parts":[[2014,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Generalized pustular psoriasis (<jats:styled-content style=\"fixed-case\">GPP<\/jats:styled-content>) is a severe but rare variant of psoriasis. Our objective is to review the clinical profile, comorbidities, and outcome of patients with <jats:styled-content style=\"fixed-case\">GPP<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>A retrospective note review of all patients with adult\u2010onset <jats:styled-content style=\"fixed-case\">GPP<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 102 patients with adult\u2010onset <jats:styled-content style=\"fixed-case\">GPP<\/jats:styled-content> were diagnosed between 1989 and November 2011, with a female to male ratio of 2\u00a0:\u00a01. The mean age at onset of <jats:styled-content style=\"fixed-case\">GPP<\/jats:styled-content> was 40.9\u00a0years (range: 21\u201381\u00a0years). Acute <jats:styled-content style=\"fixed-case\">GPP<\/jats:styled-content> was the most common variant seen (95 cases), followed by four localized variants of <jats:styled-content style=\"fixed-case\">GPP<\/jats:styled-content> and three with annular pustular psoriasis. Fever and painful skin were present in 89% of patients, arthritis in 34.7%, and leukocytosis in 78.4%. Common triggers were systemic steroids (45 cases), pregnancy (17 cases), and upper respiratory tract infections (16 cases). A positive family history of psoriasis and <jats:styled-content style=\"fixed-case\">GPP<\/jats:styled-content> was present in 29% and 11%, respectively. Comorbidities included obesity (42.9%), hypertension (25.7%), hyperlipidemia (25.7%), and diabetes mellitus (23.7%). The mean duration of admission and pustular flare for acute <jats:styled-content style=\"fixed-case\">GPP<\/jats:styled-content> was 10.3\u00a0days (range: 3\u201344\u00a0days) and 16\u00a0days (range: 7\u201360\u00a0days), respectively. Fifty\u2010four patients responded to systemic retinoid, 21 to methotrexate, eight to cyclosporine, and one to adalimumab, but recurrences were common.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our study confirms the poor response of <jats:styled-content style=\"fixed-case\">GPP<\/jats:styled-content> to currently available anti\u2010psoriatic agents, with frequent flare\u2010ups. There is a need for a more effective targeted therapy for this condition.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ijd.12070","type":"journal-article","created":{"date-parts":[[2013,8,23]],"date-time":"2013-08-23T03:34:48Z","timestamp":1377228888000},"page":"676-684","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":229,"title":["Clinical profile, morbidity, and outcome of adult\u2010onset generalized pustular psoriasis: analysis of 102 cases seen in a tertiary hospital in Johor, Malaysia"],"prefix":"10.1111","volume":"53","author":[{"given":"Siew Eng","family":"Choon","sequence":"first","affiliation":[{"name":"Department of Dermatology Hospital Sultanah Aminah Johor Bahru Johor Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nai Ming","family":"Lai","sequence":"additional","affiliation":[{"name":"Paediatric and Child Health Research Group Department of Paediatrics University of Malaya 50603 Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norshaleyna A","family":"Mohammad","sequence":"additional","affiliation":[{"name":"Department of Dermatology Hospital Sultanah Aminah Johor Bahru Johor Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nalini M","family":"Nanu","sequence":"additional","affiliation":[{"name":"Department of Dermatology Hospital Sultanah Aminah Johor Bahru Johor Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwee Eng","family":"Tey","sequence":"additional","affiliation":[{"name":"Department of Dermatology Hospital Sultanah Aminah Johor Bahru Johor Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shang Fern","family":"Chew","sequence":"additional","affiliation":[{"name":"Department of Dermatology Hospital Sultanah Aminah Johor Bahru Johor Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,8,22]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01910970"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2133.1968.tb11947.x"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/0190-9622(91)70025-W"},{"key":"e_1_2_6_5_1","unstructured":"Malaysian Psoriasis registry2010\/publicationshttp:\/\/www.acrm.org.my\/dermreg\/documents\/DermReg_Annual%20Report%202007-2009.pdf. 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