Augey F, Renaudier P, Nicolas JF. Generalized pustular psoriasis (Zumbusch): a French epidemiological survey. Eur J Dermatol. 2006;16:669-673.
Bachelez H. Pustular Psoriasis: The dawn of a new era. Acta Derm Venereol. 2020;100:adv00034.
Bachelez H, Choon SE, Marrakchi S, et al. Inhibition of the interleukin-36 pathway for the treatment of generalized pustular psoriasis. N Engl J Med. 2019;380:981-983.
Boehner A, Navarini AA, Eyerich K. Generalized pustular psoriasis -- a model disease for specific targeted immunotherapy, systematic review. Exp Dermatol. 2018;27:1067-1077.
Borges-Costa J, Silva R, Gonçalves L, et al. Clinical and laboratory features in acute generalized pustular psoriasis: a retrospective study of 34 patients. Am J Clin Dermatol. 2011;12:271-276.
Burns T, Breathnach S, Cox N, et al, eds. Rook's Textbook of Dermatology, Volume 1, Eighth Edition. Blackwell Publishing Ltd; 2010.
Choon SE, Lai NM, Mohammad NA, et al. Clinical profile, morbidity, and outcome of adult-onset generalized pustular psoriasis: analysis of 102 cases seen in a tertiary hospital in Johor, Malaysia. Int J Dermatol. 2014;53:676-684.
gov identifier: NCT03619902. A Study to Evaluate the Efficacy and Safety of ANB019 in Subjects With Generalized Pustular Psoriasis (GPP). https://clinicaltrials.gov/ct2/show/NCT03619902?term=NCT03619902. Accessed July 16, 2020.
gov identifier: NCT03782792. A Study to Test BI 655130 in Patients With a Flare-up of a Skin Disease Called Generalized Pustular Psoriasis. https://clinicaltrials.gov/ct2/show/NCT03782792?cond=Generalized+Pustular+Psoriasis&intr=spesolimab&fund=2&draw=2&rank=2. Accessed July 16, 2020.
Dieude P, Sbidian E, Viguier M, et al. Neutrophilic cholangitis in psoriasis vulgaris and psoriatic arthritis. Br J Dermatol. 2013;168:216-218.
Hoegler KM, John AM, Handler MZ, et al. Generalized pustular psoriasis: a review and update on treatment. J Eur Acad Dermatol Venereol. 2018;32:1645-1651.
Fujita H, Terui T, Hayama K, et al. Japanese guidelines for the management and treatment of generalized pustular psoriasis: the new pathogenesis and treatment of GPP. J Dermatol. 2018;45:1235-1270.
Global Report on Psoriasis. WHO 2016. https://apps.who.int/iris/bitstream/handle/10665/204417/9789241565189_eng.pdf?sequence=1&isAllowed=y. Accessed July 8, 2020.
Gooderham MJ, Van Voorhees AS, Lebwohl MG. An update on generalized pustular psoriasis. Expert Rev Clin Immunol. 2019;15:907-919.
Johnston A, Xing X, Wolterink L, et al. IL-1 and IL-36 are dominant cytokines in generalized pustular psoriasis. J Allergy Clin Immunol. 2017;140:109-120.
Kharawala S, Golembesky AK, Bohn RL, Esser D. The clinical, humanistic, and economic burden of generalized pustular psoriasis: a structured review. Expert Rev Clin Immunol. 2020;16:239-252.
Ly K, Beck KM, Smith MP, et al. Diagnosis and screening of patients with generalized pustular psoriasis. Psoriasis (Auckl). 2019;9:37-42.
Marrakchi S, Guigue P, Renshaw BR, et al. Interleukin-36-receptor antagonist deficiency and generalized pustular psoriasis. N Engl J Med. 2011;365:620-628.
Mirza H, Badri T. Generalized pustular psoriasis. In: StatPearls [Internet]. StatPearls Publishing; 2020.
Mrowietz and Prinz, In: Braun-Falco's Dermatology, Springer, 2020 (in press).
Navarini AA, Burden AD, Capon F, et al. European consensus statement on phenotypes of pustular psoriasis. J Eur Acad Dermatol Venereol. 2017;31:1792-1799.
Onoufriadis A, Simpson MA, Pink AE, et al. Mutations in IL36RN/IL1F5 are associated with the severe episodic inflammatory skin disease known as generalized pustular psoriasis. Am J Hum Genet. 2011;89:432-437.
Robinson A, Van Voorhees AS, Hsu S, et al. Treatment of pustular psoriasis: from the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol. 2012;67:279-288.
Takeichi T, Akiyama M. Generalized pustular psoriasis: clinical management and update on autoinflammatory aspects. Am J Clin Dermatol. 2020;21:227-236.
Trivedi MK, Vaughn AR, Murase JE. Pustular psoriasis of pregnancy: current perspectives. Int J Womens Health. 2018;10:109-115.
Twelves S, Mostafa A, Dand N, et al. Clinical and genetic differences between pustular psoriasis subtypes. J Allergy Clin Immunol. 2019;143:1021-1026.
Viguier M, Allez M, Zagdanski AM, et al. High frequency of cholestasis in generalized pustular psoriasis: evidence for neutrophilic involvement of the biliary tract. Hepatology. 2004;40:452-458.

WebMD Global requires each individual who is in a position to control the content of one of its educational activities to disclose any relevant financial relationships occurring within the past 12 months that could create a conflict of interest.

Faculty

Jonathan Barker, MD

Professor of Medical Dermatology and Consultant Dermatologist
St. John's Institute of Dermatology
Guy's and St Thomas's Hospitals
London, UK

Disclosures

Disclosure: Jonathan Barker, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: AbbVie Inc.; Almirall Hermal GmbH; Amgen Inc.; Boehringer Ingelheim Pharmaceuticals, Inc.; Celgene Corporation; Eli Lilly and Company; Janssen Pharmaceuticals; LEO Pharma; Novartis Pharmaceuticals Corporation; Samsung; Sun Pharma
Served as a speaker or a member of a speakers bureau for: AbbVie Inc.; Almirall Hermal GmbH; Amgen Inc.; Boehringer Ingelheim Pharmaceuticals, Inc.; Celgene Corporation; Eli Lilly and Company; Janssen Pharmaceuticals; LEO Pharma; Novartis Pharmaceuticals Corporation; Samsung; Sun Pharma
Received grants for clinical research from: AbbVie Inc.; Almirall Hermal GmbH; Amgen Inc.; Boehringer Ingelheim Pharmaceuticals, Inc.; Celgene Corporation; Eli Lilly and Company; Janssen Pharmaceuticals; LEO Pharma; Novartis Pharmaceuticals Corporation; Samsung; Sun Pharma

Melinda Gooderham, MD

Medical Director at SKiN Centre for Dermatology
Investigator with Probity Medical Research
Assistant Professor at Queens University
Consultant Physician at the Peterborough Regional Health Centre
Peterborough, Ontario, Canada

Disclosures

Disclosure: Melinda Gooderham, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: AbbVie Inc.; Actelion Pharmaceuticals, Ltd; Akros; Amgen Inc.; Bausch & Lomb Inc.; Boehringer Ingelheim Pharmaceuticals, Inc.; Celgene Corporation; Eli Lilly and Company; Galderma Laboratories, L.P.; Glenmark; Janssen Pharmaceuticals; Kyowa; LEO Pharma; Novartis Pharmaceuticals Corporation; Pfizer Inc.; Regeneron Pharmaceuticals, Inc.; Sanofi; Sun Pharmaceuticals; UCB Pharma, Inc.
Served as a speaker or a member of a speakers bureau for: AbbVie Inc.; Actelion Pharmaceuticals, Ltd; Akros; Amgen Inc.; Bausch & Lomb Inc.; Boehringer Ingelheim Pharmaceuticals, Inc.; Celgene Corporation; Eli Lilly and Company; Galderma Laboratories, L.P.; Glenmark; Janssen Pharmaceuticals; Merck & Co., Inc; Novartis Pharmaceuticals Corporation; Pfizer Inc.; Regeneron Pharmaceuticals, Inc.; Sanofi; Sun Pharmaceuticals; UCB Pharma, Inc.
Other: AbbVie Inc.; Akros; Amgen Inc.; Bausch & Lomb Inc.; Boehringer Ingelheim Pharmaceuticals, Inc.; Bristol-Myers Squibb Company; Celgene Corporation; Coherus; Dermira Inc.; Eli Lilly and Company; Galderma Laboratories, L.P.; Glenmark; Janssen Pharmaceuticals; Kyowa; LEO Pharma; MedImmune Inc.; Merck & Co., Inc.; Novartis Pharmaceuticals Corporation; Pfizer Inc.; Regeneron Pharmaceuticals, Inc.; Roche Holdings AG; Sanofi; Sun Pharmaceuticals; UCB Pharma, Inc.

Ulrich Mrowietz, MD

Head of Psoriasis-Center
Dept. of Dermatology, Venerology and Allergology
University Medical Center Schleswig-Holstein
Kiel, Germany

Disclosures

Disclosure: Ulrich Mrowietz, MD, has disclosed the following financial relationships:
Served as an advisor or consultant for: AbbVie; Almirall; Aristea, Boehringer-Ingelheim; Celgene, Dr. Reddy’s; Eli Lilly; Foamix, Formycon; Forward Pharma; Janssen; LEO Pharma, Medac, Novartis; Pierre
Fabre; Sanofi-Aventis; UCB; Xenoport
Served as a speaker or a member of a speakers bureau for: AbbVie; Almirall; Boehringer-Ingelheim; Celgene; Eli Lilly; Janssen; LEO Pharma; Medac; Novartis; UCB
Received grants for clinical research from: AbbVie; Almirall, Celgene; Forward Pharma; Novartis; UCB

Luis Puig, MD, PhD

Director
Hospital de la Santa CreuI Sant Pau
Universitat Autònomade Barcelona
Barcelona, Spain

Disclosures

Disclosure: Luis Puig, MD, PhD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: AbbVie Inc.; Almirall Hermal GmbH; Amgen Inc.; Baxalta; Biogen; Boehringer Ingelheim Pharmaceuticals, Inc.; Celgene Corporation; Eli Lilly and Company; Freseius-Kabi; Janssen Pharmaceuticals; JS BIOCAD; LEO Pharma; Mylan Laboratories Inc.; Novartis Pharmaceuticals Corporation; Pfizer Inc.; Regeneron Pharmaceuticals, Inc.; Roche Holdings AG; Sandoz; Samsung-Bioepis; Sanofi; UCB Pharma, Inc.
Served as a speaker or a member of a speakers bureau for: AbbVie Inc.;Almirall Hermal GmbH; Amgen Inc.; Boehringer Ingelheim Pharmaceuticals, Inc.; Celgene Corporation; Eli Lilly and Company; Janssen Pharmaceuticals; LEO Pharma; Mylan Laboratories Inc.; Novartis Pharmaceuticals Corporation; Pfizer Inc.; Regeneron Pharmaceuticals, Inc.; Roche Holdings AG; Sandoz; Samsung-Bioepis; Sanofi; UCB Pharma, Inc.
Received grants for clinical research from: Celgene Corporation; Eli Lilly and Company; Janssen Pharmaceuticals; Novartis Pharmaceuticals Corporation; Pfizer
Owns stock, stock options, or bonds from: AbbVie Inc.; Almirall Hermal GmbH; Amgen Inc.; Boehringer Ingelheim Pharmaceuticals, Inc.; Celgene Corporation; Eli Lilly and Company; Janssen Pharmaceuticals; LEO Pharma; Novartis Pharmaceuticals Corporation; Pfizer Inc.; Regeneron Pharmaceuticals, Inc.; Roche Holdings AG; Sanofi; UCB Pharma, Inc.

Editor

Marinella Calle, PhD, CMPP

Medical Education Director, WebMD Global, LLC

Disclosures

Disclosure: Marinella Calle, PhD, CMPP, has disclosed no relevant financial relationships.

Content Reviewer

Robert Morris, PharmD

Associate Director, Accreditation and Compliance

Disclosures

Disclosure: Robert Morris, PharmD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: ViiV Healthcare
Owns stock, stock options, or bonds from: GlaxoSmithKline

Peer Reviewer

This activity has been peer reviewed and the reviewer has disclosed no relevant financial relationships.

CPD

Generalized Pustular Psoriasis: What Do You Know?

Authors: Jonathan Barker, MD; Melinda Gooderham, MD; Ulrich Mrowietz, MD; Luis Puig, MD, PhD
CPD Released: 7/23/2020
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 7/23/2021

Start Activity

Target Audience and Goal Statement

This educational activity is intended for an international audience of non-US dermatologists and primary care physicians.

The goal of this activity is to provide foundational education about generalized pustular psoriasis (GPP), the causes of the disease, clinical signs and symptoms and the impact of associated complications that can occur in patients with this skin disease.

Upon completion of this activity, participants will:

Have increased knowledge regarding the
- Causes of GPP
- Clinical characteristics of GPP
- Complications associated with GPP

Disclosures

Faculty

Jonathan Barker, MD

Professor of Medical Dermatology and Consultant Dermatologist
St. John's Institute of Dermatology
Guy's and St Thomas's Hospitals
London, UK

Disclosures

Disclosure: Jonathan Barker, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: AbbVie Inc.; Almirall Hermal GmbH; Amgen Inc.; Boehringer Ingelheim Pharmaceuticals, Inc.; Celgene Corporation; Eli Lilly and Company; Janssen Pharmaceuticals; LEO Pharma; Novartis Pharmaceuticals Corporation; Samsung; Sun Pharma
Served as a speaker or a member of a speakers bureau for: AbbVie Inc.; Almirall Hermal GmbH; Amgen Inc.; Boehringer Ingelheim Pharmaceuticals, Inc.; Celgene Corporation; Eli Lilly and Company; Janssen Pharmaceuticals; LEO Pharma; Novartis Pharmaceuticals Corporation; Samsung; Sun Pharma
Received grants for clinical research from: AbbVie Inc.; Almirall Hermal GmbH; Amgen Inc.; Boehringer Ingelheim Pharmaceuticals, Inc.; Celgene Corporation; Eli Lilly and Company; Janssen Pharmaceuticals; LEO Pharma; Novartis Pharmaceuticals Corporation; Samsung; Sun Pharma

Melinda Gooderham, MD

Medical Director at SKiN Centre for Dermatology
Investigator with Probity Medical Research
Assistant Professor at Queens University
Consultant Physician at the Peterborough Regional Health Centre
Peterborough, Ontario, Canada

Disclosures

Disclosure: Melinda Gooderham, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: AbbVie Inc.; Actelion Pharmaceuticals, Ltd; Akros; Amgen Inc.; Bausch & Lomb Inc.; Boehringer Ingelheim Pharmaceuticals, Inc.; Celgene Corporation; Eli Lilly and Company; Galderma Laboratories, L.P.; Glenmark; Janssen Pharmaceuticals; Kyowa; LEO Pharma; Novartis Pharmaceuticals Corporation; Pfizer Inc.; Regeneron Pharmaceuticals, Inc.; Sanofi; Sun Pharmaceuticals; UCB Pharma, Inc.
Served as a speaker or a member of a speakers bureau for: AbbVie Inc.; Actelion Pharmaceuticals, Ltd; Akros; Amgen Inc.; Bausch & Lomb Inc.; Boehringer Ingelheim Pharmaceuticals, Inc.; Celgene Corporation; Eli Lilly and Company; Galderma Laboratories, L.P.; Glenmark; Janssen Pharmaceuticals; Merck & Co., Inc; Novartis Pharmaceuticals Corporation; Pfizer Inc.; Regeneron Pharmaceuticals, Inc.; Sanofi; Sun Pharmaceuticals; UCB Pharma, Inc.
Other: AbbVie Inc.; Akros; Amgen Inc.; Bausch & Lomb Inc.; Boehringer Ingelheim Pharmaceuticals, Inc.; Bristol-Myers Squibb Company; Celgene Corporation; Coherus; Dermira Inc.; Eli Lilly and Company; Galderma Laboratories, L.P.; Glenmark; Janssen Pharmaceuticals; Kyowa; LEO Pharma; MedImmune Inc.; Merck & Co., Inc.; Novartis Pharmaceuticals Corporation; Pfizer Inc.; Regeneron Pharmaceuticals, Inc.; Roche Holdings AG; Sanofi; Sun Pharmaceuticals; UCB Pharma, Inc.

Ulrich Mrowietz, MD

Head of Psoriasis-Center
Dept. of Dermatology, Venerology and Allergology
University Medical Center Schleswig-Holstein
Kiel, Germany

Disclosures

Disclosure: Ulrich Mrowietz, MD, has disclosed the following financial relationships:
Served as an advisor or consultant for: AbbVie; Almirall; Aristea, Boehringer-Ingelheim; Celgene, Dr. Reddy’s; Eli Lilly; Foamix, Formycon; Forward Pharma; Janssen; LEO Pharma, Medac, Novartis; Pierre
Fabre; Sanofi-Aventis; UCB; Xenoport
Served as a speaker or a member of a speakers bureau for: AbbVie; Almirall; Boehringer-Ingelheim; Celgene; Eli Lilly; Janssen; LEO Pharma; Medac; Novartis; UCB
Received grants for clinical research from: AbbVie; Almirall, Celgene; Forward Pharma; Novartis; UCB

Luis Puig, MD, PhD

Director
Hospital de la Santa CreuI Sant Pau
Universitat Autònomade Barcelona
Barcelona, Spain

Disclosures

Disclosure: Luis Puig, MD, PhD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: AbbVie Inc.; Almirall Hermal GmbH; Amgen Inc.; Baxalta; Biogen; Boehringer Ingelheim Pharmaceuticals, Inc.; Celgene Corporation; Eli Lilly and Company; Freseius-Kabi; Janssen Pharmaceuticals; JS BIOCAD; LEO Pharma; Mylan Laboratories Inc.; Novartis Pharmaceuticals Corporation; Pfizer Inc.; Regeneron Pharmaceuticals, Inc.; Roche Holdings AG; Sandoz; Samsung-Bioepis; Sanofi; UCB Pharma, Inc.
Served as a speaker or a member of a speakers bureau for: AbbVie Inc.;Almirall Hermal GmbH; Amgen Inc.; Boehringer Ingelheim Pharmaceuticals, Inc.; Celgene Corporation; Eli Lilly and Company; Janssen Pharmaceuticals; LEO Pharma; Mylan Laboratories Inc.; Novartis Pharmaceuticals Corporation; Pfizer Inc.; Regeneron Pharmaceuticals, Inc.; Roche Holdings AG; Sandoz; Samsung-Bioepis; Sanofi; UCB Pharma, Inc.
Received grants for clinical research from: Celgene Corporation; Eli Lilly and Company; Janssen Pharmaceuticals; Novartis Pharmaceuticals Corporation; Pfizer
Owns stock, stock options, or bonds from: AbbVie Inc.; Almirall Hermal GmbH; Amgen Inc.; Boehringer Ingelheim Pharmaceuticals, Inc.; Celgene Corporation; Eli Lilly and Company; Janssen Pharmaceuticals; LEO Pharma; Novartis Pharmaceuticals Corporation; Pfizer Inc.; Regeneron Pharmaceuticals, Inc.; Roche Holdings AG; Sanofi; UCB Pharma, Inc.

Editor

Marinella Calle, PhD, CMPP

Medical Education Director, WebMD Global, LLC

Disclosures

Disclosure: Marinella Calle, PhD, CMPP, has disclosed no relevant financial relationships.

Content Reviewer

Robert Morris, PharmD

Associate Director, Accreditation and Compliance

Disclosures

Disclosure: Robert Morris, PharmD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: ViiV Healthcare
Owns stock, stock options, or bonds from: GlaxoSmithKline

Peer Reviewer

This activity has been peer reviewed and the reviewer has disclosed no relevant financial relationships.

Accreditation Statements

For Physicians

The Faculty of Pharmaceutical Medicine of the Royal Colleges of Physicians of the United Kingdom (FPM) has reviewed and approved the content of this educational activity and allocated it 0.50 continuing professional development credits (CPD).

Contact WebMD Global

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

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There are no fees for participating in or receiving credit for this online educational activity. For information about your eligibility to claim credit, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent participating in the activity. To successfully earn credit, participants must complete the activity online during the credit eligibility period that is noted on the title page.

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Read the information provided on the title page regarding the target audience, learning objectives, and author disclosures, read and study the activity content and then complete the post-test questions. If you earn a passing score on the post-test and we have determined based on your registration profile that you may be eligible to claim CPD credit for completing this activity, we will issue you a CPD credit certificate.
Once your CPD credit certificate has been issued, you may view and print the certificate from your CME/CE Tracker. CPD credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of the Medscape Education homepage.

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*The credit that you receive is based on your user profile.

From Medscape Education

CPD

Generalized Pustular Psoriasis: What Do You Know?

Authors: Jonathan Barker, MD; Melinda Gooderham, MD; Ulrich Mrowietz, MD; Luis Puig, MD, PhDFaculty and Disclosures

THIS ACTIVITY HAS EXPIRED FOR CREDIT

CPD Released: 7/23/2020

Valid for credit through: 7/23/2021

processing....

Contents of This CPD Activity

All sections of this activity are required for credit.

Generalized Pustular Psoriasis: What Do You Know?

Dr Barker covers the prevalence and causes of GPP.
Jonathan Barker, MD

Signs and Symptoms of Generalized Pustular Psoriasis

Dr Mrowietz presents the signs and symptoms of GPP.
Ulrich Mrowietz, MD

Impact of Generalized Pustular Psoriasis on Patients' Lives

Dr Puig covers the impact of this skin disease on patients.
Luis Puig, MD, PhD

Therapeutic Management of Generalized Pustular Psoriasis

Dr Gooderham presents the current options for treatment of GPP.
Melinda Gooderham, MD

Concluding Remarks

Dr Barker outlines the conclusions of the activity.
Jonathan Barker, MD

Educational Impact Challenge

Before you begin this activity, please assess your clinical knowledge by completing this brief survey. Answering these questions again after the activity will allow you to see what you learned and to compare your answers with those of your peers.

Page 1 of 8

CPD Information Download Slides

Activity Transcript

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Disclaimer

The educational activity presented above may involve simulated, case-based scenarios. The patients depicted in these scenarios are fictitious and no association with any actual patient, whether living or deceased, is intended or should be inferred. The material presented here does not necessarily reflect the views of Medscape, LLC, or any individuals or commercial entities that support companies that support educational programming on medscape.org. These materials may include discussion of therapeutic products that have not been authorized by the European Medicines Agency for use in Europe, off-label uses of authorized products, or data that were presented in abstract form. These data should be considered preliminary until published in a peer-reviewed journal. Readers should verify all information and data before treating patients or employing any therapies described in this or any educational activity. A qualified healthcare professional should be consulted before using any therapeutic product discussed herein.

References

Faculty and Disclosures

Faculty

Jonathan Barker, MD

Melinda Gooderham, MD

Ulrich Mrowietz, MD

Luis Puig, MD, PhD

Editor

Marinella Calle, PhD, CMPP

Content Reviewer

Robert Morris, PharmD

Peer Reviewer

CPD

Generalized Pustular Psoriasis: What Do You Know?

Target Audience and Goal Statement

Disclosures

Faculty

Jonathan Barker, MD

Melinda Gooderham, MD

Ulrich Mrowietz, MD

Luis Puig, MD, PhD

Editor

Marinella Calle, PhD, CMPP

Content Reviewer

Robert Morris, PharmD

Peer Reviewer

Accreditation Statements

For Physicians

Instructions for Participation and Credit

Generalized Pustular Psoriasis: What Do You Know?

Contents of This CPD Activity

Generalized Pustular Psoriasis: What Do You Know?

Signs and Symptoms of Generalized Pustular Psoriasis

Impact of Generalized Pustular Psoriasis on Patients' Lives

Therapeutic Management of Generalized Pustular Psoriasis

Concluding Remarks

Educational Impact Challenge