The European Commission just gave new hope to a condition that’s had few real options
Generalized pustular psoriasis, or GPP, doesn’t look like typical psoriasis. Instead of raised, scaly patches, it causes widespread pus-filled bumps and sudden waves of full-body inflammation severe enough to land patients in the hospital. It’s rare, and until now, treatment options have stayed frustratingly limited.
That could be changing. As reported by Dermatology Times, the European Commission has granted orphan designation to imsidolimab, an investigational antibody treatment from Vanda Pharmaceuticals. It’s the first time the European Commission has granted this status to any drug for GPP, and it follows similar designations the treatment already secured in the United States and Japan.
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How Imsidolimab Targets GPP
Imsidolimab works by blocking a protein pathway called IL-36, which researchers believe is a major driver of GPP flares. Rather than calming symptoms after the fact, it’s designed to interrupt the inflammatory signal at the source, the same targeted approach behind a newer generation of psoriasis treatments aiming to go deeper than older options.
An Orphan Designation Isn’t an Approval, Yet
It’s easy to see “European Commission” and assume the treatment is cleared for patients, but that’s not quite the case. Orphan designation is a regulatory status reserved for treatments aimed at rare, serious diseases, and it can come with incentives like reduced fees and market exclusivity that help push development forward. It doesn’t mean imsidolimab is approved.
In the US, the therapy is further along: its application is currently under FDA review, with a decision expected by December 12.
What Vanda Is Saying
“The European Commission’s Orphan Designation for imsidolimab represents an important milestone for the GPP community and for our efforts to bring this investigational therapy to patients in Europe,” said Mihael H. Polymeropoulos, MD, president, chief executive officer and chairman of the board of Vanda Pharmaceuticals. “With orphan designations now received in Europe, the United States and Japan, we remain focused on advancing imsidolimab for patients in these markets who need new treatment options.”
What This Means for You
If imsidolimab clears the remaining regulatory hurdles, it could give patients with this unpredictable and often frightening form of psoriasis a dedicated treatment option, something that’s been hard to come by. It’s part of a broader shift in how dermatologists are approaching psoriasis treatment, with more targeted options in the pipeline. For now, this designation is another sign that a once-overlooked condition is finally getting more attention from drug developers, with the next real test, that US decision, landing by mid-December.
Student and advocate Alina Vue shares the challenges and triumphs of living with generalised pustular psoriasis and psoriatic arthritis
Between early morning classes and late night study sessions, no one ever said college was easy. But for Alina Vue, a 25-year-old student based in Westminster, CO, it’s been especially tough juggling classes and not one, but two forms of psoriasis. “This is my second attempt at college; I was in my second year before I took my hiatus,” shares Vue, who is currently studying communications at Front Range Community College.
Vue was just two years old when her mother first noticed splotchy rashes on her skin. “At first, they thought it was just baby eczema. That’s pretty common with the kids in my family,” says Vue, who is Hmong American. So her parents did as most would: moisturized her skin well and sought to reduce irritation via home remedies.
“But it kept getting worse,” Vue explains. One day, her skin not only turned really red, but felt very hot to the touch. Worried this was far beyond eczema, her mother rushed Vue to the local emergency room in Green Bay, WI. There, a doctor quickly recognized the symptoms of generalized pustular psoriasis (GPP), which include inflamed skin, fever, fatigue, nausea, weight loss, itching, muscle weakness, headaches, and the tell-tale painful pus-filled white and yellow bumps.
“I vividly remember being very itchy,” Vue says. “I’m glad that I was diagnosed, because it is a pretty severe experience. My mom was my champion. She was clear that something was wrong.”
While the National Psoriasis Foundation estimates that 2% to 3% of the population has one of the five types of psoriasis, only about 1%of those cases are GPP. The low prevalence is one of the reasons Vue likes to share her story. “People tend to think psoriasis is just a skin thing, and it definitely relates to the skin, but it’s an autoimmune disease, so it’s definitely more than what they think it is. It’s inflammatory, so it can lead to organ issues, I’ve had swollen feet, I’ve lost a lot of weight unexpectedly. It’s an all-around intense health issue separate from the skin itself,” Vue says.
Finding the Pattern
By the time Vue was old enough to start kindergarten, her health was locked into a pattern: a massive flare each winter, followed by recovery each summer. “I would have this dual experience throughout the year of like, ‘Ah, everything’s fine!’ and then come my birthday in September, things would start getting worse again. I have a lot of memories of not being able to do recess because I lived in a very cold climate. I did a lot of activities in bed because it was very hard to move around,” Vue says.
By the time Vue reached third grade, her condition had gotten more severe, leading her mother to homeschool her for a year. “That was one of the worst bouts of my psoriasis because it was just so hyper-aggressive. It was a tumultuous time and I was very sedentary,” remembers Vue.
She filled her days drawing and writing poetry with a cousin. She credits her father with the inspiration to put pen to paper. “My father is a pastor, and he used to write sermons all the time, so words were a big part of my childhood. But I also didn’t know how to tell people things, and writing was a more accessible tool for me to express myself,” says Vue.
These days, she’s tapping that tool for school. The severity of her conditions has meant that she hasn’t yet been able to work a job, but she’s excited to put her talent to good use after graduation. “I love film and design, and I would love to be in the film industry as a graphic designer or social media marketer, or even in spaces where I can talk about movies and fashion and art,” she says.
Adding a Diagnosis
Vue returned to school for fourth grade, but not before being thrown for another loop. In late 2009, when she was nine, she noticed a new pain. “I was struggling with swollen ankles,” she says. But her inflamed joints didn’t seem like a big deal until she was hospitalized for two weeks for her pustular psoriasis. “I was very sick. I remember being in the hospital and in the midst of it all, doctors recognized that I also had the presentation of psoriatic arthritis,” she says.
Psoriatic arthritis is an autoimmune condition in which the immune system doesn’t just attack the skin, but it goes after the joints, tendons, and ligaments, leaving pain, swelling, and stiffness in its wake. About one in every three people with psoriasis will develop this painful condition (2.4 million people in the United States alone), though it is usually diagnosed between the ages of 35 and 55. Studies estimate that about 15% people with this condition have not yet been diagnosed.
If left untreated, psoriatic arthritis can cause permanent joint damage. That’s definitely a concern for Vue, who says the condition has always felt undertreated, with doctors mostly relying on the medications for her GPP to treat both. “I'm trying to see a rheumatologist right now,” she shares.
Experimenting With Treatments
Middle school is tough for everyone, but it hit Vue especially hard. At the start of sixth grade, she experienced a flare so bad it put her back in homeschool.
Courtesy of Alina Vue
“I had a very hard time walking because the pain was aggressive. So I was sitting all the time, mostly at a table doing my homework. But after a month or so, the skin behind my knees started closing up, and then my legs started atrophying,” Vue shares. Unable to straighten her legs or walk on them, she was hospitalized again, and it took two months of physical therapy to get her back on her feet. “It was a very trying time.”
It was also a time of experimentation. Like most chronic illnesses, psoriasis can be treated with many types of medications. And like most chronic illnesses, it can be tough to land on the right, unique combination that will facilitate a person’s best life.
Vue is no exception. She’s been on several topical medications, most notably triamcinolone, a corticosteroid that she used for four years and discontinued because it thinned her skin and sensitized it. She’s taken oral systemic medications, including immunosuppressants cyclosporine (“tasted horrible and didn’t change anything”) and methotrexate (“actually made me more itchy”), with little success. She also tried UV light therapy, but that just “made me feel like a cupcake in a display case.”
It wasn’t until 2010 that Vue’s doctors introduced biologics, which are injected or IV-infused medications that target relevant portions of the immune system, rather than smothering the entire thing. She started with Humira (adalimumab), an injectable that worked for a year before abruptly stopping. Then she moved to IV infusion Remicade (infliximab)for a year until it triggered anaphylaxis, her body developing antibodies against the medication and her throat closing up.
Seeing her child gasp for air brought Vue’s mom to a breaking point. Vue moved to virtual school (where she stayed through graduation), and they took two years off medications, trying ultimately unsuccessful home remedies, including some from their Hmong culture like eating eucalyptus leaves for their anti-inflammatory properties.
Testing Genetics
By age 16, Vue was ready to try medications again, starting with injections of Stelara (ustekinumab), which blocks the IL-12 and IL-23 proteins in the immune system. Again, it worked for a year before failing, throwing 17-year-old Vue into yet another flare.
Lucky for Vue, her doctor had a new plan. “She asked if we’d be okay with doing genetic testing to see if there’s a specific mutation causing my psoriasis, because there are certain medications that specifically target that, which would make it easier for recovery,” Vue says. “I said, ‘Yes!’ and they found my specific mutation and the right medication for me.”
It turned out, Vue has a mutation of the IL36RN gene, which makes a protein called interleukin 36 receptor antagonist (IL-36Ra). Researchers have linked this mutation (along with more than a dozen others) to GPP, as it reduces the amount of the protein in the skin of people like Vue, clearing the way for uncontrolled inflammation.
That led them to try Taltz (ixekizumab), a biologic that works by blocking interleukin-17A (IL-17A), another inflammation-causing protein linked to GPP. While Taltz is marketed as a medication for psoriatic arthritis and the more common plaque psoriasis, researchers have found that it can successfully treat GPP, too.
More than that, the autoinjector works for Vue, effectively putting her GPP into remission for seven years. “It really worked well, but my mom and I were wary, because so many things stopped working at the one-year mark,” she says. “But then it kept going, and I haven’t experienced a lot of major side effects. It’s the longest I’ve ever gone without a flare. Sometimes I’m still surprised, but I’m so glad.”
Still, Taltz, plus a skincare regimen of vitamin D topical cream and CeraVe, is not perfect. It hasn’t helped with her psoriatic arthritis as hoped, and as an immunosuppressant, it can open users up to infection. Vue got a taste of that in 2024, when a combination of summer heat and an infection she caught during an unmasked Mother’s Day photo shoot triggered her first GPP flare since starting Taltz. That touched off a new pattern; it flared again summer of 2025.
Sharing Her World
Courtesy of Alina Vue
While she’s in a good place now, Vue doesn’t shy away from sharing the highs and the lows of living with psoriasis. She was diagnosed with major depressive disorder in 2024, but notes that the online psoriasis community has been pivotal to finding her footing.
“Psoriasis has significantly affected my mental health. Even though I grew up with very supportive people, it still felt like I was always in a bubble and separate from everyone,” she shares. “But seeing other people in the community talking about it and knowing that I wasn’t the only one with these intense feelings made me feel like I could carry less weight. Hearing them say, ‘This is who I am, and it’s okay,’ made me feel more confident and safer in the world.”
Ultimately, her experience with psoriasis has taught her some important lessons beyond what she could pick up in a classroom. “It’s difficult, but it’s also a beautiful opportunity to understand ourselves and each other,” she shares. “I have learned so much about my own humanity. There is so much beauty to be had from just witnessing other people’s journeys and being witnessed back.”
Psoriasis can be a challenge to manage when it’s on your feet. Experts share the treatments and lifestyle tweaks that can help
Managing your psoriasis often means taking things like setbacks and treatment plans step by step. But those metaphorical steps get a little trickier if the psoriasis is on your feet.
The chronic skin condition, which happens when the immune system goes into overdrive and triggers skin cells to grow abnormally, can occur on almost any part of the body, including the feet. Often, its signature symptoms include patches of skin inflamed, thick, dry, or scaly skin. Some people with psoriasis also experience small depressions in their toenails called pitting.
Here’s the catch: Research shows that psoriasis on the feet, also known as palmoplantar psoriasis, can be more disabling than psoriasis on other parts of the body because it can easily interfere as someone moves around and goes about normal day-to-day activities. But it doesn’t have to sit you down for good. Here, learn more about the symptoms to look for and get expert advice on how to treat and manage foot psoriasis.
Types of Psoriasis That Affect Your Feet
There are several different types of psoriasis that can affect your feet, just as they can affect other parts of the body. Here’s a breakdown of the four types that are seen most frequently:
Plaque Psoriasis
Plaque psoriasis is the most common type of psoriasis on the feet (it’s also the most common type of psoriasis in general). It looks like thick, scaly, red or pink raised areas of skin (or plaques), often on the bottom of the feet. “These plaques can often cause itching, burning, and discomfort,” says Andrea Hui Austin, M.D., a board-certified dermatologist at Bay Area Cosmetic Dermatology in San Francisco. “The nails may also be affected, with thickening and pitting—which looks like tiny holes on the surface of the nail—or splitting of the nails.”
In people with darker skin, the plaques are rarely red or pink. Instead, they may be various shades of brown, purple, or gray, and may have silvery scales.
Guttate Psoriasis
When someone has guttate psoriasis, they typically break out in small, red, scaly patches often throughout the body (including the feet). The condition often comes on suddenly and people usually develop it after having strep throat or an upper respiratory infection.
Pustular Psoriasis
“Pustular psoriasis is characterized by tiny yellow fluid-filled blisters on the feet,” Dr. Austin says. “This can be extremely painful and can lead to dried scaling on the feet.” Youcan develop pustular psoriasis anywhere on your body, but it’s most common on the palms of your hands and the soles of your feet.
Psoriatic Arthritis
Some people with psoriasis have a form of arthritis called psoriatic arthritis, which involves symptoms like joint pain, swelling, and stiffness. The joint pain can occur anywhere throughout your body, including your toes, heels, tendons, and toenails.
“Psoriatic arthritis can appear concurrently with other forms of psoriasis that affect the feet,” Dr. Austin says.
Symptoms of Psoriasis on Your Feet
Foot psoriasis symptoms can vary from one person to the next and can also be different depending on which type of psoriasis you have. These symptoms are some of the most common, according to Cleveland Clinic:
Discoloured skin
Dry skin
Itching and burning skin
Thick, scaly, red plaques on the skin
Tiny depressions in the toenails called pitting
Causes
No one knows exactly what causes psoriasis on the body—including when psoriasis symptoms show up on your feet—but it’s believed that the condition is brought on by a combination of triggers including genetics, an overactive immune system, environmental factors, and skin irritation. “Psoriasis is considered an autoimmune condition whereby the immune system mistakenly targets healthy skin cells and leads to their dysregulation,” Dr. Austin says.
Difference Between Foot Psoriasis and Athlete’s Foot
It can be challenging to tell the difference between psoriasis and athlete’s foot since both conditions cause a lot of the same symptoms. But to properly treat whatever is causing your symptoms—especially if you’ve never been diagnosed with either condition—you’ll want to see a dermatologist who can examine your skin.
Though it can be hard to tell apart athlete’s food and psoriasis, one helpful way to differentiate between the two is to pay attention to which area of the feet is affected. “Psoriasis usually involves the top and bottom of the feet,” says Shari Lipner, M.D., a board-certified dermatologist at Weill Cornell Medicine in New York City. “Athlete’s foot involves the bottom of the feet and in between the toes.” Here are a few more differences between foot psoriasis and athlete’s foot, per Dr. Lipner:
Cause: Foot psoriasis is a chronic autoimmune skin condition that results from an overactive immune system. Athlete’s foot is a contagious fungal infection caused by dermatophytes (fungi that thrives in warm, moist environments).
Appearance: Foot psoriasis typically appears as red, scaly patches or plaques on the feet. Athlete’s foot usually presents as red, peeling skin between the toes or on the soles of the feet. It may also cause blisters or infected open sores.
Itching: Foot psoriasis can be itchy, and the affected skin may crack, bleed, or become painful. Itching also happens with athlete’s foot, but it is also often accompanied by a burning sensation.
Common Symptoms: In addition to redness and scaling, individuals with foot psoriasis may experience nail changes on the toes, such as pitting, thickening, or discoloration. Athlete’s foot is primarily a fungal infection and does not affect the nails.
Treating Psoriasis on Your Feet
Most treatments for foot psoriasis aim to alleviate pain and discomfort and reduce symptom flare-ups. Usually this involves topical treatments and/or light therapy for the affected skin area, or systemic medications that treat psoriasis as a whole.
“Psoriasis of the feet can be challenging to treat due to constant pressure from weight, warm and moist environment in shoes, and daily activities such as walking,” Dr. Austin says. “With the help of a board-certified dermatologist, a successful treatment plan can be established to help a patient overcome their psoriasis.”
Let’s look at some common foot psoriasis treatments:
Topical Treatments
These treatments, applied directly to the affected skin, can help reduce inflammation, slow down skin cell growth, and alleviate itching, providing relief for people living with psoriasis. Common types of topical treatments for psoriasis on feet include:
Coal tar: Coal tar shampoos (you can use them on your body, too), foams, and ointments are an effective psoriasis treatment that help bring some people into long periods of remission.
Creams and ointments: Most cases of psoriasis are mild or moderate in severity and can be treated with creams and ointments. These can help bring symptoms like itching and swelling under control.
Salicylic acid: Salicylic acid has exfoliating properties and can help clear up flaking skin. “Emollients containing salicylic acid can help to soften and flatten the characteristic thick scales of psoriasis,” Dr. Austin says. “They can also help topical prescriptions such as corticosteroids penetrate the skin and provide healing effects.”
Topical corticosteroids: Available over-the-counter and by prescription, topical corticosteroids are a type of medication that’s available in various forms, including creams, ointments, and gels. They help reduce redness, itching, and inflammation.
Systemic Treatments
Systemic treatments are a type of prescription medication that work throughout the entire body. Some systemic medications commonly prescribed for psoriasis on the feet include:
Biologics:Biologics target the specific part of the immune system that causes psoriasis flares, Dr. Austin explains. They’re often used as a treatment for people with moderate or severe psoriasis when other treatments like topical creams and corticosteroids don’t help bring symptoms under control.
Oral corticosteroids: “For more severe cases, oral corticosteroids can be used to manage the immune system from within,” Dr. Austin says.
Phototherapy
Phototherapy, or light therapy, is a treatment used for various skin conditions, including psoriasis. Under the care of a dermatologist, this treatment emits UV light is emitted from a device that’s either full-body-sized or smaller and targeted to a specific area like your feet.
Lifestyle Tweaks
Changing up your lifestyle in some ways can sometimes help manage psoriasis and lower your chances of experiencing a psoriasis flare. You can approach this in a few ways, according to Cleveland Clinic:
Limiting alcohol: Alcohol can sometimes make psoriasis symptoms worse, research shows. By saying no to that wine or beer, you may be less likely to experience psoriasis symptoms brought on by alcohol use.
Not smoking: Research shows that smoking can increase your risk of developing psoriasis. It can also make your psoriasis more severe, and you may be less responsive to some treatments. If you quit smoking, some psoriasis symptoms may improve.
Proper foot care: Wearing breathable socks, washing your feet often, and regularly moisturizing may help prevent flare-ups.
Reducing stress: Studies have found that reducing stress can play an important role in managing psoriasis.
Takeaways
When psoriasis affects the feet, you may notice symptoms such as redness, thickening of the skin, dryness, and the presence of scaly patches. Additionally, nail abnormalities like small depressions can occur. While plaque psoriasis is the most prevalent type found on the feet, other variations exist. Managing foot psoriasis typically involves making lifestyle adjustments and using topical creams. In severe cases, oral medications may be necessary. If you aren’t sure if the itchy rash on your feet is psoriasis or not, your first step is to make an appointment with your doctor for confirmation.
