Generalized pustular psoriasis (GPP) can be more than just a skin issue. It can have a large impact on your mental health, too.
The disorder causes redness or discoloration on skin. Bumps or pustules on top of the skin are filled with pus, though it’s not due to an infection. Though you can’t spread GPP to others, you may not want to be around them if the rash is visible.
“GPP is a rare, painful form of psoriasis that can seriously affect both physical and mental well-being,” says Maria Knobel, MD, a general practitioner in London. “The visible skin symptoms, combined with the unpredictability of flare-ups, often lead to significant mental health challenges for patients. Many feel anxious or isolated, worrying about the appearance of their skin and the impact it has on their daily lives.”
GPP can be even more unpredictable compared to other types of psoriasis, says Danilo Del Campo, MD, a dermatologist from Chicago.
“Flares can escalate quickly and may occur without obvious triggers, which makes it challenging to anticipate. This unpredictability adds to the emotional burden, as patients often feel a lack of control over their symptoms,” he says.
Psychological Effects of GPP
Flares can be life-threatening, which can cause a great deal of anxiety. GPP can cause widespread pain, even when you’re not actively flaring. This can lead to more distress.
“Mental health issues like depression and anxiety are, unfortunately, very common [in those with GPP],” says Knobel.
In fact, with GPP you’re 1.5 times more likely to have depression and anxiety compared to people without psoriasis, a 2022 report found.
“I see patients who avoid social situations and feel trapped by their condition, especially when treatments don’t completely control symptoms,” Knobel says.
Sham Singh, MD, a psychiatrist from California, agreed that the pain, discomfort, and visible symptoms can cause isolation, self-consciousness, and low self-confidence.
“Probably anxious or depressed — and frequently fighting the battle of trying to keep stress at bay — patients can be 'on edge' waiting for their next flare-up,” says Singh. “It is quite common that individuals afflicted with GPP will show increased emotional disturbances because of the unpredictable and, at times, painful nature of their disease.”
Most people feel like others don't understand them or judge them because GPP is rare, making it hard to find support in their peers, Singh says.
“Such a lack of being understood might further develop into growing feelings of loneliness, and therefore it is important that such patients have mental health support available for them,” he says.
Ray Lauzums, a Wisconsin resident with GPP, was one of those people. He sought professional help and joined online support groups to cope with the emotional effects of GPP.
“I knew I needed help when my GPP outbreaks started messing up my daily routine,” Lauzums says.
“The nonstop itching, feeling tired all the time, and the skin problems made me feel alone and nervous. I had a hard time with feeling bad about myself and being down, and it got worse when I had outbreaks,” he says.
The Role of Stress in GPP Flares
Emotional stress can cause your GPP to flare. At the same time, a flare can stress you out.
A 2022 survey on Americans with GPP showed that emotional stress was the most common cause of flares. Of respondents, 67% had fear and anxiety about their disorder, 71% had a fear of flares, 65% worried that their medication would stop working, 59% said they felt hopeless and depressed, and 56% worried that their GPP would get worse with time.
This is why managing stress is so critical. Doing so may be able to prevent a flare and deal with the emotions that can come with one.
Recognizing a GPP flare
Know the symptoms of a flare so you can expect what your body and mind may need. For example, if you have a hard time dealing with anxiety during a flare, set up an appointment with your therapist when symptoms begin.
The symptoms of GPP include:
- Fever
- Chills
- Intense itching
- Rapid pulse
- Headache
- Joint pain
- Fatigue
- Nausea
- Muscle weakness
GPP complications
Complications of GPP can be as emotionally upsetting as symptoms. Being aware of them may make you feel anxious, but it can also encourage you to treat a flare and avoid complications. These complications can include sudden drops in blood pressure; tetany (involuntary muscle contractions); delirium; renal, respiratory, or cardiac failure; sepsis; jaundice; and death.
Fortunately, there are ways to get support so you can manage your condition and feel your best.
Depression and Anxiety Symptoms
Psoriasis in general is tied to higher chances of poor mental health, but GPP comes with even higher odds.
“GPP is typically more variable and more severe than other forms of psoriasis. The immune system defect in GPP causes more sudden changes in inflammation and disease severity,” says Steven R. Feldman, MD, a professor of dermatology at Wake Forest University School of Medicine.
In a 2022 study, participants with GPP reported more anxiety and depression compared to those with plaque psoriasis. In fact, 28.3% with GPP had a history of anxiety compared to 17.1% with plaque psoriasis while 31.7% of participants with GPP reported a history of depression compared to 17.1% with plaque psoriasis. Schizophrenia and suicidal ideation are more common in people with psoriasis compared to those without, according to a different report published the same year.
“GPP is horrible,” says Feldman. “It can make people feel acutely and chronically ill. But like other severe skin conditions, GPP can be socially disabling with resulting depression.”
Know the symptoms of depression and anxiety so you can tell if you need to get professional help.
Signs of depression include:
- Feeling sad or hopeless
- Irritability and anger
- Loss of interest in normal activities
- Sleep problems including not being able to sleep or sleeping too much
- Low energy
- Anxiety
- Difficulty focusing and remembering things
- Back pain and headaches
- Thoughts of death or suicide
Signs of anxiety include:
- Nervousness and panic attacks
- Feeling like something bad is going to happen
- Difficulty controlling worry
- Increased heart rate
- Sweating and trembling
- Exhaustion
- Breathing rapidly (hyperventilation)
- Difficulty concentrating
- Sleeping interruptions
- Stomach and gastrointestinal issues
- Avoiding what makes you feel anxious
How to Get Help for GPP-Related Mental Health Issues
If you have chronic emotional issues that mess with your daily functioning or you feel hopeless, seek professional support, says Singh.
“Talk therapy is very helpful,” he says. “It allows the patient to process his or her feelings, create a coping mechanism, and learn stress management techniques that can be life-altering in managing chronic illness-related stress.”
Support groups and teletherapy can help, too, says Singh.
Combining talk therapy with community support often provides the best relief, Knobel says.
Lauzums knows firsthand how valuable support can be.
“Getting therapy changed things for me. Cognitive-behavioral therapy (CBT) helped me deal with my anxiety and being down by changing how I thought about things,” he says. “Plus, online groups gave me a place to belong and understand what others with similar problems were going through.”
Mary Robinson, a resident of Florida who also has GPP, says it’s important to mentally prepare for flare-ups to occur, even if you’re doing everything you’re supposed to.
“That mindset has helped me shift my focus to the things I can control, like my diet, exercise, and managing stress,” she says. “It’s also so important to listen to your body — know when you’re pushing yourself too hard, and don’t ignore the signs it’s giving you. Rest and self-care aren’t weaknesses … they’re necessities.”
Mary leans on her personal network for support when she needs it, which has also helped her mentally.
“Having people who understand or are willing to learn about what you’re going through can make a huge difference.”
Show Sources
Photo Credit: iStock/Getty Images
SOURCES:
Maria Knobel, MD, general practitioner, London.
Danilo Del Campo, MD, dermatologist, Chicago, Illinois.
Sham Singh, MD, psychiatrist, California.
Ray Lauzums, GPP patient. Wisconsin.
Steven R. Feldman, MD, professor of dermatology, Wake Forest University School of Medicine.
Mary Robinson, GPP patient, Florida.
National Psoriasis Foundation: “Pustular Psoriasis,” “Generalized Pustular Psoriasis.”
American Academy of Dermatology Association: “Pustular psoriasis: Treatment.”
Cleveland Clinic: “Pustular Psoriasis.”
American Journal of Clinical Dermatology: “Impact of Generalized Pustular Psoriasis from the Perspective of People Living with the Condition: Results of an Online Survey.”
General Hospital Psychiatry: “Associations between psoriasis and mental illness: an update for clinicians.”
National Organization for Rare Disorders: “Generalized Pustular Psoriasis.”
StatPearls Publishing: “Generalized Pustular Psoriasis.”
Journal of Psoriasis and Psoriatic Arthritis: “The Disease Burden of Generalized Pustular Psoriasis: Real-World Evidence From CorEvitas’ Psoriasis Registry.”
Mayo Clinic: “Depression (major depressive disorder),” “Anxiety disorders.”
