GENERALISED pustular psoriasis (GPP) prevalence increased by more than 50% in England between 2008 and 2022, while patients with GPP had substantially higher mortality risk and reduced life expectancy compared with people without the condition.
The population-based cohort study used primary care and hospital records linked with mortality, ethnicity and deprivation data. Among 25.8 million people, 991 patients with GPP were identified, of whom 63% were female, 86% were White, 10% were Asian and 3% were Black, Mixed or Other.
GPP prevalence increased from 20.9 per million in 2008 to 32.5 per million in 2022. Incidence remained stable until 2016 before increasing, reaching 4.9 per million person-years. The mean age at GPP onset was 51.4 years, with onset occurring earlier among Asian patients than White patients.
Patients with GPP had more than three times the risk of all-cause mortality compared with people without GPP (adjusted hazard ratio [aHR]: 3.19; 95% confidence interval [CI]: 2.58–3.91).
Mortality rates were also elevated for several specific causes of death, including neoplasms, respiratory, digestive and circulatory diseases. The strongest association was observed for sepsis, for which the mortality risk was substantially higher among patients with GPP (aHR: 9.76; 95% CI: 4.92–19.35).
The study also identified differences in GPP prevalence by sex, ethnicity and age. Prevalence was higher among females, Asian people and older age groups, highlighting variation in the epidemiology of the condition across population groups.
Life expectancy was reduced among patients with GPP, with a younger age at diagnosis associated with the greatest reduction in expected lifespan.
The researchers concluded that the increasing prevalence, differences by sex and ethnicity, and elevated mortality risk demonstrated a substantial clinical burden associated with GPP. They highlighted the need for targeted strategies to reduce preventable morbidity and mortality.
The observational design identifies associations rather than establishing that GPP directly caused the reported mortality outcomes. The findings nevertheless provide population-level data on the epidemiology and mortality burden of GPP in England over a 15-year period.
Reference
Wright AK et al. Incidence, prevalence, and life expectancy of patients with generalised pustular psoriasis in England: a population-based cohort study exploring ethnic and sex variations. Br J Dermatol. 2026;DOI:10.1093/bjd/ljag417.
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