{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T13:46:18Z","timestamp":1791985578802,"version":"4.4.0"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100020950","name":"National Science and Technology Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100020950","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010101","name":"Taichung Veterans General Hospital","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100010101","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Generalized pustular psoriasis (GPP) is a rare, severe inflammatory disease with limited evidence on long-term prognosis and treatment\u2013mortality associations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare mortality and major comorbidities in GPP, psoriasis vulgaris (PV), and non-psoriatic individuals, and treatment\u2013mortality associations in GPP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Adults with GPP, psoriasis vulgaris (PV) without pustular psoriasis, and non-psoriatic controls were identified. GPP patients were 1:1 propensity score\u2013matched to PV and non-psoriatic controls by age, sex, and race. Among GPP patients, those receiving biologics, conventional anti-psoriatic drugs, or small-molecule inhibitors were separately matched to patients treated with systemic corticosteroids alone. Primary outcome was all-cause mortality; secondary outcomes included major mortality-related comorbidities based on the ten leading causes of death per US CDC. Kaplan\u2013Meier and Cox models estimated cumulative incidence and hazard ratios.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After matching, 6,959 GPP\u2013PV and 28,459 GPP\u2013non-psoriatic pairs were analyzed. Over 5 years, GPP patients had higher 5-year mortality than PV (HR, 1.83; 95% CI, 1.28\u20132.59) and non-psoriatic controls (HR, 2.42; 95% CI, 1.99\u20132.94). Major comorbidity risks were higher in GPP than in PV, notably ischemic heart disease (HR, 1.34; 95% CI, 1.01\u20131.78), cerebrovascular disease (HR, 1.62; 95% CI, 1.06\u20132.47), and neurodegenerative disease (HR, 2.94; 95% CI, 1.47\u20135.89), and were elevated across all evaluated comorbidities compared with non-psoriatic controls. Mortality risks were particularly pronounced in patients &amp;gt;60 years and males. Among GPP patients, biologic therapy was associated with lower mortality than systemic corticosteroids alone (HR, 0.71; 95% CI, 0.52\u20130.96), whereas conventional anti-psoriatic drugs and small-molecule inhibitors were not.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>GPP is associated with higher mortality and comorbidity risk than PV and non-psoriatic individuals. Biologic therapy was associated with lower mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1885617","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T06:42:58Z","timestamp":1788417778000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-term comorbidities and mortality associations with treatment in generalized pustular psoriasis: a multi-institutional cohort study"],"prefix":"10.3389","volume":"17","author":[{"given":"Teng-Li","family":"Lin","sequence":"first","affiliation":[{"name":"Department of Dermatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation","place":["Chiayi, Taiwan"]},{"name":"Ph.D. Program of Interdisciplinary Medicine, National Yang Ming Chiao Tung University","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Hsuan","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Chung Shan Medical University Hospital","place":["Taichung, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuo-Sheng","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Chest Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation","place":["Chiayi, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao-Kuei","family":"Juan","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Taichung Veterans General Hospital","place":["Taichung, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Ju","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Taichung Veterans General Hospital","place":["Taichung, Taiwan"]},{"name":"Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University","place":["Taichung, Taiwan"]},{"name":"Faculty of Medicine and Institute of Clinical Medicine, National Yang Ming Chiao Tung University","place":["Taipei, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Ying","family":"Wu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Institute of Clinical Medicine, National Yang Ming Chiao Tung University","place":["Taipei, Taiwan"]},{"name":"Institute of Biomedical Informatics, National Yang Ming Chiao Tung University","place":["Taipei, Taiwan"]},{"name":"Division of Translational Research, Taipei Veterans General Hospital","place":["Taipei, Taiwan"]},{"name":"College of Public Health, China Medical University","place":["Taichung, 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