Keeping score: novel method might help differentiate 2 serious skin diseases

Two rare skin conditions with similar symptoms can be mistaken for each other, so a scoring system has been formulated to aid physicians in distinguishing two diseases

Close-up of skin symptoms. A scoring system has been developed to help distinguish between two diseases.
Left: generalized pustular psoriasis (GPP). Right: acute generalized exanthematous pustulosis (AGEP).

Your skin becomes red and spots filled with pus appear, so you visit a dermatologist. When these symptoms spread to the skin throughout the body, it is difficult for the physician to distinguish whether it is generalized pustular psoriasis (GPP) or acute generalized exanthematous pustulosis (AGEP), as both have similar symptoms. The two diseases run different courses and require different treatments. Without proper treatment, the symptoms can worsen severely and cause complications, so it is essential to distinguish between them.

Researchers from Osaka Metropolitan University and the Mayo Clinic in the United States have developed a scoring system as a novel tool to distinguish between the two diseases. Led by Dr. Mika Yamanaka-Takaichi and Professor Daisuke Tsuruta, both from the Department of Dermatology at OMU’s Graduate School of Medicine, and Professor Afsaneh Alavi from the Department of Dermatology at the Mayo Clinic in Rochester, Minnesota, the team studied data on clinical symptoms and laboratory findings of the diseases to create the system.

The study looked at 54 patients with GPP and 63 patients with AGEP who over a two-decade span had sought treatment at OMU or the Mayo Clinic medical group.

“The results of this research might help medical professionals distinguish between GPP and AGEP, which have been difficult to differentiate in clinical practice. We hope the scoring system we suggest can lead to quicker diagnosis and the choosing of appropriate treatment,” Dr. Yamanaka-Takaichi said. “In the future, we aim to establish a diagnostic index that clinicians can use practically to differentiate between the two diseases.”

Their findings were published in the Journal of the American Academy of Dermatology.


About OMU 

Osaka Metropolitan University is the third largest public university in Japan, formed by the merger of Osaka City University and Osaka Prefecture University in 2022. OMU upholds the “Convergence of Knowledge” through 11 undergraduate schools, a college, and 15 graduate schools. For more research news, visit and follow us on X @OsakaMetUniv_en, Instagram, and Facebook.

Published: 18 Mar 2024

Contact details:

Rina Matsuki

3-3-138 Sugimoto, Sumiyoshi-ku,
Osaka 558-8585 JAPAN

Academic discipline: 
Content type: 

Title: Differentiating generalized pustular psoriasis from acute generalized exanthematous pustulosis
DOI: 10.1016/j.jaad.2024.01.080
Authors: Mika Yamanaka-Takaichi, Miki Watanabe, Nneka I. Comfere, Olayemi Sokumbi, Christeebella O. Akpala, Austin Todd, Emily L. Branch, Aaron R. Mangold, Sho Hiroyasu, Daisuke Tsuruta, and Afsaneh Alavi
Publication date: March 14, 2024

Funding information:

The Japanese Dermatological Association