Take control of your GPP

Source: Boehringer Ingelheim

Our long-term partner, company Boehringer Ingelheim has updated and re-released the website GPP&Me just last week. Considering that the website includes many materials with downloadable options, we at EUROPSO thought it would be useful to share with with our psoriasis community. We have tried to put together the highlights from this resource, hoping it would be helpful for you or somebody you care about.

Understanding generalized pustular psoriasis (GPP)

Because GPP is rare, it can take time to find the right doctor. Not all doctors may be familiar with it. And if they recognise it, they still may need to do additional tests to confirm the diagnosis.

Some people may have to see several doctors before GPP is correctly diagnosed. In general, if you have widespread painful, pustules on your skin and have other symptoms like fever, joint pain, and extreme tiredness, you may have GPP.

A dermatologist (skin specialist) is the right doctor to diagnose GPP, but it may take a few visits. A doctor may refer you to another dermatologist who is an expert in GPP.

Once you find the right dermatologist, they may ask about your symptoms, medical history, and any family history of skin disease. They may also need to do blood tests or even look at a small piece of skin under a microscope, called a biopsy, to make the correct diagnosis and decide how best to help you.

Understanding flare triggers may help you manage your disease

A flare is when symptoms appear suddenly

Flares may start with the skin turning red and feeling tender, and then pus-filled blisters (pustules) can appear within hours. The blisters may join together, creating “lakes” of pus. 

Early signs of a flare

Remember how you felt before your last flare? Did your skin turn red and tender with pustules appearing within hours? Did the blisters or pustules combine to form “lakes” of pus? Did you have fever, joint pain, and extreme tiredness?

The next time you feel that way, or the way you felt as a flare occurred, contact your dermatologist right away.

Flares may be unpredictable

Your flares may not always show up the same way and they may appear anywhere on the body. You can’t predict when you may have a flare, or how severe it will be—it can happen any time, last for weeks, and take months to heal. Many patients experience continued symptoms between flares.

Common triggers

Recognising triggers can help manage your disease. Pay attention to how your body feels before a flare. You may have a general feeling of uneasiness, decreased appetite, and nausea before the pustules appear. The most common triggers for GPP flares are:

  • Infection
  • Stress
  • Pregnency
  • Starting or stopping some steroid medicines and pain relievers
  • Withdrawal of steroid treatment
  • Irritating skin creams or ointments
  • Too much sunlight

Helpful tips

If you feel a flare coming on, you may require medical care

Any flare can be serious and may require medical care and, in some cases, lead to hospitalisation. Although rare, complications from a flare can be life-threatening. If you feel a flare coming on, stay calm. Contact your dermatologist when you see or feel the first signs of a flare; they may prescribe a medication. You and your dermatologist may want to discuss the best procedure for ensuring you are seen in a timely fashion when you think you may be having a flare.

Carry information with you that contains your with general practitioner’s and your dermatologist’s contact details

This way, any healthcare provider can check with your dermatologist before treating you. It’s important to get the right treatment as soon as possible for the best results.

Proactively inform all your healthcare providers that you have GPP so they can give you the best care.

Hear from people living with GPP

GPP affects everyone differently. Learn from other people’s experiences with GPP and build your support network.

Visit this link to see other people’s stories and how is their life with GPP.

Featured image: Pixabay.com

Why does my psoriasis seem to get worse in winter

Fall and winter bring shorter days. Shorter days mean less sunlight and Vitamin D. At the same time, colder temperatures mean more clothing layers covering your skin. When combined, these factors might bring the worsening of psoriasis symptoms.

In this period of year, we naturally tend to spend more time in closed spaces and due to the heating, the air in these spaces sometimes gets really dry. On the other side, dry wither air in Europe is not exactly favourable for psoriasis either. In fact, the lack of humidity in the air outside and the dry heat in most buildings during fall and winter can have the same undesired effect on your skin- depriving it of the moisture it needs. If you take this into account and combine it with the fact that your body is in this period usually covered from head to toe and not getting enough ultraviolet light, it becomes understandable why your skin is more likely to flare and your plaques worsen in winter.

Keeping skin soft and moist can minimize itching and tenderness. Over-the-counter moisturizers such as petroleum jelly or thick creams may be recommended. These should be applied immediately after bathing or showering.

The dryness-related psoriasis symptoms could also be relieved with the help of air humidifier in the space where you spend the most of your day, be it an office or your home. However, safely getting the ultraviolet light your skin needs might not be that easy. The UV tanning is definitely not an option for various reasons, among which the risk of getting melanoma takes the highest place.

In the attempt to compensate the sunlight, your doctor might recommend medical use of light rays to treat psoriasis. This is known as phototherapy[i]. This therapy comes in a variety of options, and can be done in a doctor’s office, psoriasis clinic, or even in your home.

The form of light known as ultraviolet light B (UVB) seems to be the most beneficial for treating psoriasis. Depending on your symptoms you might be prescribed a certain amount of UVB exposure. If your doctor does choose this form of light therapy for your psoriasis, ask whether you should consider purchasing a home UVB unit.

Holiday season and psoriasis

Winter is also time for holidays. Some people get psoriatic flares around holidays but, contrary to some beliefs, the key triggers[ii] for symptoms are not food and alcohol. The experts have established that the main reason behind  worsening of symptoms for winter holidays lays in stress. It is known that stress is a psoriasis trigger, and there are people who find the holidays very stressful. In addition to that, heavy drinking, smoking and exchanging viruses at social gatherings may also increase the psoriasis symptoms.

What should I do to help myself then?

We have asked Primarius M.Sc Pij Bogomir Marko, MD from Slovenia for an advice.

„All of the previously mentioned reasons might make your life with psoriasis more difficult in wintertime. My first recommendation is- adhere to your therapy. If you are prescribed a medication for psoriasis, make sure that you are compliant and you take your medicine on time. The other advice is- if you feel stressed out, find something that helps you relax. And finally, even though the wither food is delicious and you don’t feel like exercising, try to follow as healthy a lifestyle as possible. Let that be your Christmas present to yourself. “

About psoriasis

Psoriasis is an immune-mediated disease[iii] that causes raised, red, scaly patches to appear on the skin. It typically affects the outside of the elbows, knees or scalp, though it can appear on any location.

Some people report that psoriasis is itchy, burns and stings. Psoriasis is associated with other serious health conditions, such as diabetes, heart disease and depression.

Between 10 and 30% of people with psoriasis develop arthritis, and it can occur at any time, although it is most likely to appear between the ages of 30 and 50. It is not possible to know who will suffer from psoriatic arthritis, as there are no blood tests to predict it. Psoriatic arthritis is a form of chronic inflammation of the joints characterised by redness, swelling and pain in the affected joints.

In addition, there is a rare form of psoriatic disease, called Generalized Pustular Psoriasis (GPP), which is both physically and genetically different from Plaque Psoriasis. Pustules often cover large areas of the body and typically presents with fever, shivers, intense itching, a rapid pulse, fatigue, headache, nausea, muscle weakness, and joint pain. Flares can also cause life-threatening complications, such as a sudden drop in blood pressure.

[i] American Academy of Dermatology Association, https://www.aad.org/public/diseases/psoriasis/treatment/medications/phototherapy

[ii] WebMD, https://www.webmd.com/skin-problems-and-treatments/psoriasis/7-psoriasis-triggers

[iii] National library of medicine, Psoriasis as an Immune-Mediated and Inflammatory Systemic Disease: From Pathophysiology to Novel Therapeutic Approaches, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8615182/