A Clinical Analysis Of 120 Cases Of Generalized Pustular Psoriasis

Objective:To analyze the clinical characteristics,laboratory tests and treatment options of generalized pustular psoriasis?GPP?patients,to explore the pathogenesis of GPP,and to evaluate the outcomes.Method:Clinical data of 146 hospital information from 120 patients with GPP?22 cases of children,98 cases of adults?from the Department of Dermatology,Lanzhou university Second Hospital,were retrospectively analyzed.Analyze the database by SPSS 22.0 software.Results:1)This study included 120 patients,of which 63 patients were male,57 patients were female,male to female ratio was 1.11:1,of which 98 patients were adults?>14years?,22 patients were children??14 years?,ratio of 4.45:1,of which 95 patients were without history of psoriasis vulgaris(GPP^PSO–),and 25 patients were with history of psoriasis vulgaris(GPP^PSO+),ratio of 3.80:1.2)The probability of male induced by the upper respiratory tract?41.50%?was higher than that of female?18.75%???²=8.593,P=0.003?.The onset age and hospitalization age of female patients were?29.33±18.12?years and?33.89±18.17?years which were earlier than those of male patients'?38.05±18.13??t=2.855,P=0.05?and?40.21±18.26?years?t=2.079,P=0.039?.3)In both GPP^pso-patients and GPP^pso+patients,the upper respiratory infection and drugs were the main etiological factors.The GPP^PSO-patients were mainly induced by colds?45.45%???²=3.844,P=0.050?and the GPP^PSO+patients were mainly induced by drugs?28.32%???²=5.181,P=0.023?.The onset age in GPP^PSO-group was earlier than that in GPP^PSO+group[?25.16±18.09?years vs?36.75±18.57?years,?t=2.790,P=0.006?].And the hospitalization time and the pustular extinction time in GPP^PSO-group were much longer than those in GPP^PSO+patients[?11.94±5.50?days vs?10.44±3.13?days?t=-1.997,P=0.048?;?8.03±4.25?days vs?5.85±2.08?days?t=-4.052,P=0.000?],respectively.Therefore,the onset age of GPP^PSO-patients was earlier,and the severity of acute exacerbation period was more severe than that of GPP^PSO+patients.4)The children patients tended to develop in summer?40.00%?and the adults were in spring?34.71%???²=8.724,P=0.033?.The upper respiratory infection was the main etiological factor in children?52.00%?more than that in adults?27.27%???²=8.724,P=0.033?.The main predisposing factors were the cold?27.27%?and the drugs?25.62%?in adult with GPP^PSO-patients?45.45%???²=4.481,P=0.034?.The GPP^PSO+patientsinadultweremainlyinducedbydrugs?30.30%???²=6.267,P=0.012?.The probability of GPP^pso-patients?45.45%?was higher than in adults?15.31%???²=9.901,P=0.002?.5)The average age of hospitalization in the low-calcium group was higher than that in the non-hypocalcemia group[?44.27±16.46?years vs?34.77±18.54?years,?t=2.867,P=0.005],and their pustular extinction time was longer than that in the non-hypocalcemia group[?7.23±3.50?days vs?6.08±2.58?days,?t=2.212,P=0.029?].The fever rate in patients with hypocalcemia?28 cases,68.29%?was higher than that in the non-hypocalcemia group?49 cases,46.67%???2=5.533,P=0.019?,and their fever temperature after medication?38.82±0.66??was higher than that of non-low calcium group?38.38±0.69???t=2.771,P=0.007?.Moreover,the probability of hypoproteinemia,anemia,low potassium and abnormal liver function was higher in patienswithhypocalcemiawashigherthanthatofnon-hypocalcemia patients.Therefore,the patients with hypocalcemia were more likely to develop fever than that without hypocalcemia,and their highest temperature after medication was higher,and the incidence of complications in the low-calcium group such as low protein,anemia,low potassium and abnormal liver function was higher than those in the non-low-calcium group.6?In this group,52.74%of the patients still had fever after treatment,36.36%of them had high fever?39.1⁴1.0??and 33.77%had moderate fever?38.1³9.0??.29.87%of the patients had low fever?37.3³8.0??.There was a strong positive correlation between the highest fever temperature and the febrile time?P=0.000,R=0.630?,and a moderate positive correlation with the pustule extinction time?P=0.000,R=0.450?,a weak positive correlation with the length of hospitalization?P=0.003,R=0.337?.There was a positive correlation between the time of fever and the time of pustular regression?P=0.000,R=0.662?,and a moderate positive correlation with time of hospitalization?P=0.000,R=0.507?.Therefore,the degree of fever?the highest fever temperature and the febrile time?was closely related to the severity of the disease.7)A total of 125 patients with GPP were treated with Acitretin and Acitretin combined with total glucoside of paeony,and 103 patients were effective.The effective rate was 89.57%.Acitretin is effective in controlling the condition of GPP patients during acute attack.Conclusion:The clinical characteristics of children and adults,GPP^pso+and GPP^pso-,low-calcium group and non-low-calcium group are different.Patients with GPP are prone to fever,and fever is associated with the severity of patients.Patients in GPP^pso-group and in low-calcium group are more severe in the acute phase.Acitretin can be used as a firs-line drug for GPP and is suitable for both children and adults.