Characteristics and Outcomes of Generalized Pustular Psoriasis Patients Managed Through Inpatient Asynchronous Teledermatology: A Retrospective Study.

Abstract

Background: Inpatient teledermatology (ITD) is a growing telemedicine modality aimed at addressing the shortage of dermatologists in hospitals, particularly for the management of complex skin disorders. Generalized pustular psoriasis (GPP) is a rare and potentially life-threatening condition characterized by widespread sterile pustules and systemic inflammation. Despite advances in targeted therapies, treatment is often limited to traditional agents such as cyclosporine and infliximab, due to restrictions in formulary access and insurance coverage.

Objective: This study aimed to characterize the clinical features, treatment outcomes, and the impact of ITD on the management of hospitalized GPP patients at the University of Pittsburgh Medical Center (UPMC), with a particular focus on hospitalization duration and time to pustule resolution.

Methods: A retrospective analysis of 35 patients with pustular skin disorders between January 2015 and August 2024 was conducted. Nine biopsy-confirmed GPP cases requiring hospitalization were included. Data on demographics, comorbidities, treatment regimens, and outcomes were collected. ITD consultations provided recommendations for corticosteroid tapering and immunosuppressive therapy initiation.

Results: The cohort included nine patients, predominantly White (88.9%), with a median age of 66 years. Preexisting psoriasis and obesity were the most common comorbidities (55.6%). Leukocytosis was the most frequent lab abnormality (77.8%). The average hospitalization duration was 6.1 ± 3.8 days, and readmission occurred in 33.3% of cases. ITD consultations led to early tapering of systemic corticosteroids and initiation of immunosuppressive therapy (55.6% with cyclosporine and 33.3% with infliximab). Significant pustule improvement was achieved in 16.1 ± 7.5 days, with full resolution in 22.5 ± 17.7 days.

Conclusion: ITD significantly reduced hospitalization duration for GPP patients compared with historical controls, likely due to timely therapeutic interventions. While newer biological therapies remain restricted in many hospitals, ITD facilitated the effective use of traditional immunosuppressive therapies, improving patient outcomes. This study supports the integration of ITD in hospital care models, especially in institutions lacking in-house dermatologists. Further research should explore long-term outcomes and the role of ITD in managing other emergent dermatologic conditions.