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Generalized pustular psoriasis (GPP) is a rare chronic inflammatory skin disease that can lead to life-threatening complications and require emergency medical treatment. Recurrent GPP flares are characterized by the sudden onset of widespread erythematous skin rash with sterile pustules, at times associated with fever, chills, general malaise, and other systemic inflammatory manifestations. Systemic complications such as cardiorespiratory failure, infections, and sepsis are potentially life-threatening and can result in an emergency department visit and/or hospitalization. Acute GPP episodes can be difficult to recognize and diagnose. The low incidence of the disease, its relapsing nature, the unpredictability of flare onset, and the lack of standardized diagnostic criteria are major obstacles to achieving rapid recognition and diagnosis in both the emergency department and the hospital setting. There is scarce evidence supporting the efficacy and safety of treatments commonly used for GPP; consequently, there is an unmet need for therapies that specifically target the condition. Our aim is to present a multidisciplinary approach to GPP to achieve a rapid diagnosis ensuring that the patient receives the most appropriate treatment for their pathology. The main recommendation for primary care and emergency physicians is to contact a dermatologist immediately for advice or to refer the patient when GPP or a flare is suspected. Generalized pustular psoriasis (GPP) is a rare and serious skin disease that can cause life-threatening complications and require urgent medical treatment. When someone has a flare-up of GPP, their skin suddenly becomes red and covered with pus-filled bumps not caused by infection. They may also experience fever and chills and feel generally unwell. These flares can be very difficult to diagnose and lead to serious complications such as infections and organ failure, which may require a visit to the emergency department and/or admission to hospital. The diagnosis of GPP can be challenging as it is a rare and unpredictable disease with different types of flare-ups, making it difficult to identify in the emergency department and the hospital. This article shows that the best recommendation for primary care and emergency doctors is to improve their knowledge of this rare condition. Primary care and emergency doctors should immediately contact a dermatologist for advice or referral if they suspect that a patient has GPP or a flare-up of the disease. An approach involving doctors from different specialties can help ensure that patients receive the appropriate and timely care they need. [ABSTRACT FROM AUTHOR]

Summary Objective In this study, we have performed a direct comparison between both T-cell based assays (QFN-G-IT and T-SPOT.TB) and TST in patients with psoriasis taking different immunosuppressant drug-regimens. Methods We have prospectively studied 103 patients with moderate-to-severe psoriasis who required latent tuberculosis infection (LTBI) screening before starting systemic immunosuppressive treatment or during its sustained use. Results Overall number of positive results was 16.5%, 17.5% and 8.7% using T-SPOT.TB, QFN-G-IT and TST, respectively. Differences in the percentage of positive results between TST with T-SPOT.TB and QFN-G-IT were significant ( p = 0.005 and p = 0.008, respectively). A total of 24.3% of the subjects enrolled were positive for at least one of the three tests performed. Sixteen patients with negative TST (17%) were positive for one of the two IGRAs. We obtained seven indeterminate results by T-SPOT.TB and two by QFN-G-IT. Seven patients with negative TST presented indeterminate results by either of two IFN-γ assays. Positive TST, T-SPOT.TB and QFN-G-IT results were not affected by clinical therapeutic profile. Conclusions Our results reveal that in vitro assays are useful methods for LTBI diagnosis in patients with psoriasis, suggesting that they might be less influenced by immunosuppression than TST. [ABSTRACT FROM AUTHOR]