• Urgent dermatology assessment; hospitalization is usually required for significant acute flares.
• IV fluids and correction of electrolyte abnormalities as required.
• Monitor temperature, renal function, fluid balance, and hemodynamic status.
• Bland emollients and supportive skin care.
• Analgesia.
• Antibiotics only for suspected or confirmed secondary infection.
• Spesolimab, targeting the IL-36 receptor, is a GPP-specific targeted therapy that has changed contemporary management of acute GPP.
• Other systemic options include cyclosporine, acitretin, methotrexate, and selected TNF-α, IL-17, or IL-23 biologics depending on clinical circumstances and availability.
• Phototherapy is generally not practical for an acutely unstable flare but may have a role later in selected patients.
• Pregnancy requires coordinated dermatology-obstetric management.
