Health condition
Generalised pustular psoriasis
Generalised pustular psoriasis (GPP) is a rare, severe form of psoriasis in which sheets of sterile pustules erupt on painful red skin with fever and malaise; it can be life-threatening, and a targeted biologic (spesolimab) now exists for flares.
Why trust this guide
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Editorial team
Written by our editorial team from the UK sources listed on each page.
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Sourced from guidance
Checked against current NHS and UK specialist society guidance at the time of review.
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Current for 2026
Reviewed on 2026-09-27 with the next review scheduled for 2027-09-27.
Key facts
The essentials at a glance.
The symptoms to recognise, when to seek help, which specialist to see, and what treatment usually involves.
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Waves of tiny sterile pustules on tender red skin, coalescing into "lakes of pus", with fever and raised inflammatory markers
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The pustules contain neutrophils, not infection - though sepsis must always be excluded and can coexist
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Triggers include steroid withdrawal, infection, pregnancy (impetigo herpetiformis) and hypocalcaemia; some cases involve IL36RN gene mutations
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Flares need urgent hospital care; spesolimab, an anti-IL-36 biologic, is licensed for GPP flares alongside older options such as ciclosporin and acitretin
Understanding the condition
What it is and what happens next.
What causes it, how it is diagnosed, and the treatment routes available in the UK.
What it is and how it feels
GPP behaves more like a systemic inflammatory disease than a rash: the IL-36 pathway drives neutrophils into the skin in waves, producing crops of pustules that dry, peel and recur every few days, while the person is feverish and unwell. Distinguishing it from widespread infection matters immediately, because the treatments point in opposite directions.
Diagnosis and treatment routes
Admission for supportive care, cultures and specialist confirmation is standard during a flare, with bloods including calcium and inflammatory markers, and genetic testing considered in recurrent or familial disease. Spesolimab has transformed acute flare treatment where available; acitretin, ciclosporin, methotrexate and anti-IL-17 or anti-IL-23 biologics are used for control and prevention between flares. In much of the UK, a routine NHS referral to the relevant specialist clinic can take several months, whereas an initial appointment with a private consultant is typically available within around two weeks.
Seeing a specialist
Who to see, and how quickly you can be seen.
The specialist for this condition is usually a consultant dermatologist. Your GP can refer you on the NHS, or you can arrange a private consultation directly.
A quiet reminder
This guide is for information, not medical advice.
Your GP knows your history and can tell you which parts apply to you. If in doubt, see them - and seek urgent care for any of the emergency symptoms described above.
Frequently asked
Common questions about Generalised pustular psoriasis.
Quick, plain-English answers to what people ask us most.
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What is generalised pustular psoriasis?
Generalised pustular psoriasis is a rare, severe form of psoriasis causing widespread pus-filled blisters (pustules) on red, inflamed skin over large areas of the body, along with fever and feeling generally unwell, representing a medical emergency.
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What causes generalised pustular psoriasis?
It can be triggered by sudden withdrawal of certain medications (particularly systemic steroids), infection, pregnancy, or occur in someone with existing psoriasis, reflecting a severe intensification of the underlying immune process.
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What are the symptoms?
Widespread red, inflamed skin studded with small pus-filled pustules, often with fever, chills, and a general feeling of being unwell, distinguishing this from the more common, localised forms of psoriasis.
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Is generalised pustular psoriasis dangerous?
Yes, it's a serious medical emergency, as the extensive skin involvement can disrupt normal body temperature regulation and fluid balance, and significantly increases infection risk, requiring urgent hospital treatment.
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How is generalised pustular psoriasis treated?
Treatment requires hospital admission for supportive care alongside specific systemic psoriasis treatments, often biologics, aimed at bringing the widespread inflammation under control as rapidly as possible.
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How long does treatment take?
Initial stabilisation in hospital typically takes days to a couple of weeks, with ongoing treatment then needed to achieve and maintain control of the underlying psoriasis over subsequent months.
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Generalised vs localised pustular psoriasis — what's the difference?
Localised pustular psoriasis affects specific areas, such as the palms and soles, without causing systemic illness, while generalised pustular psoriasis affects widespread skin areas and causes fever and feeling unwell, representing a much more severe, medically urgent presentation.
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What triggers generalised pustular psoriasis flares?
Sudden withdrawal of certain medications, particularly systemic steroids, infections, and, in some cases, pregnancy, can trigger this severe flare in someone with an underlying predisposition to psoriasis.
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Can generalised pustular psoriasis be prevented?
Careful, gradual management of treatment changes, avoiding sudden withdrawal of certain medications, and prompt treatment of infections in people with psoriasis can help reduce the risk of triggering this severe form.
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When is this an emergency, and where should I go?
Widespread pustules with fever or feeling very unwell is a medical emergency: seek immediate assessment at A&E, as generalised pustular psoriasis requires urgent hospital treatment.