What Can Trigger a GPP Flare?

Living with generalized pustular psoriasis (GPP) can be stressful and unpredictable. You might not know what your GPP flare triggers are, which can make it hard to tell when a flare might happen. Is it stress? A change in medication? Or something you haven’t even thought of?

Generalized pustular psoriasis flares come on fast and may not even have an obvious cause. Dermatologist David Xiong, MD, shares some of the surprising things that can trigger a GPP flare, from genetic changes to harsh weather.

Top GPP flare triggers

GPP symptoms typically require urgent care and may even require a hospital stay. But early signs of a flare can look like other things — such as an allergic reaction, skin infection or even a bug bite — so paying close attention to new or worsening symptoms matters.

Sometimes, Dr. Xiong says that flares start spontaneously, without a clear trigger. Other times, they can be traced back to a particular GPP flare trigger … once you learn what yours are.

Everyone’s GPP triggers are different. But here’s what may be behind your flares.

Illnesses and health conditions

Illnesses and infections ramp up your immune system, which can lead to GPP symptoms.

“Infections tend to be the most common cause of the flares that I see,” Dr. Xiong shares. “Usually, these are upper respiratory infections, like the common cold, flu, strep throat or COVID-19.”

He also notes that many people with GPP have plaque psoriasis, a condition often linked to obesity or diabetes.

Medications

Stopping certain medications too quickly can trigger a GPP flare. This can include corticosteroids, like prednisone, and immunosuppressants, like cyclosporine.

This may occur due to something known as a rebound effect. When you stop these drugs suddenly instead of tapering your dose, your immune system can reactivate too strongly. That surge can set off widespread inflammation and trigger a GPP flare.

Other common triggers

“Flares sometimes can happen spontaneously,” says Dr. Xiong. “But many other triggers can cause GPP flares, even everyday things you might not consider.”

Some of these include:

• Skin injuries: Cuts, scrapes, burns or irritation can lead to a flare, sometimes causing plaques and pustules in the injured area.
• Hormonal changes: Shifts during your period, pregnancy, childbirth or menopause may trigger flares.
• Low calcium levels: Hypocalcemia can weaken your skin and make your immune system more likely to cause widespread inflammation.
• Stress: High levels of emotional or psychological stress can push your immune system into overdrive and increase flares.
• Weather and sun exposure: Cold, dry air, sudden temperature changes or too much sun (including sunburn) can trigger inflammation.
• Smoking: Using tobacco is known to increase inflammation throughout your body, which can make flares more likely.

A less-common trigger: vaccinations

In rare cases, both pre-existing plaque psoriasis and GPP reactions have been reported after vaccines for the flu, COVID-19, monkeypox or tuberculosis.

“In theory, any vaccine could cause a flare because they start an inflammatory response in your body,” Dr. Xiong explains. “But it’s very uncommon.”

Vaccinations can be an important part of your overall health — and for most people with GPP, they don’t trigger flares. Your care team can help you decide what’s right for you and when to schedule vaccinations.

Preventing GPP flares

Avoiding your flare triggers is an important part of managing GPP. Your dermatologist and rheumatologist can help you figure out what may lead to flares and create a plan to help reduce your risk.

These steps may include:

• Managing stress through relaxation techniques or talk therapy
• Taking medications as prescribed
• Treating infections like cold and flu as soon as possible
• Protecting your skin from harsh weather, sun and injuries
• Not smoking

Small steps like these can help lower the chance of flares over time.

Treating with medication

Even with lifestyle changes, Dr. Xiong explains that to fully manage generalized pustular psoriasis, you’ll likely need a medication made specifically to treat psoriasis or GPP.

“Some people with GPP can go for months to years between flares, but this isn’t typical,” he notes. “More often, you’ll have flares until you start treatment for GPP.”

Your provider may recommend a biologic medication called spesolimab (Spevigo®) to help manage your GPP and its flares. This treatment is the only medication approved specifically for treating generalized pustular psoriasis. It works by blocking the IL-36 pathway. It can also treat symptoms from a sudden flare.

“It’s a promising treatment for GPP and other related inflammatory disorders,” he adds. “Studies have shown it helps significantly.”

Your provider may also use other medications approved for treating psoriasis that can help reduce inflammation during initial treatment. There are also injections targeting other inflammatory pathways involved in psoriasis.

“There’s no foolproof solution to treating GPP,” Dr. Xiong says. “But we do see that some treatments, like spesolimab, are more effective than others.”

It’s important to work proactively with your dermatologist to make sure your medications are working for you. Let them know if you notice any improvement or have side effects. They can adjust your dosage or try something different, if needed.

Living with GPP

Generalized pustular psoriasis is a lifelong condition, so symptoms may come and go over time. Because flares can appear quickly, it’s important to watch for new or worsening signs. If a flare spreads fast or feels more severe than usual, head to the nearest emergency department right away.

“If you’re having severe symptoms, you’ll want to seek urgent care,” Dr. Xiong advises. “Severe or prolonged flares can cause significant inflammation in your body and damage multiple organs, including your eyes, kidneys, liver, joints or lungs.”

Living with GPP can make everyday life feel unpredictable. But learning what your GPP flare triggers are and how this condition behaves can help you better manage it — and feel less caught off guard when symptoms appear.