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van Ierland K, Vredevoogd C, Roach R, Clahsen P. Severe case of pustular psoriasis during pregnancy. BMJ Case Rep 2024; 17:e258198. [PMID: 38508599 PMCID: PMC10952864 DOI: 10.1136/bcr-2023-258198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
Pustular psoriasis of pregnancy (PPP) is a rare variant of generalised pustular psoriasis occurring during or after pregnancy. PPP can have significant maternal and fetal morbidity if left untreated. In this case report, we present a pregnant woman with this rare cutaneous disorder and how it was treated. Due to the limited available evidence regarding the treatment of PPP, we describe the treatment that was given based on the clinical manifestations and severity of the disease.
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Affiliation(s)
| | - Corla Vredevoogd
- Gynaecology and Obstetrics, Medisch Centrum Haaglanden Westeinde, Den Haag, The Netherlands
| | - Rachel Roach
- Dernatology, Medisch Centrum Haaglanden Westeinde, Den Haag, The Netherlands
| | - Pieter Clahsen
- Pathology, HMC Westeinde Hospital, Den Haag, The Netherlands
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2
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Joshi KS, Mohammad S, Acharya N, Joshi S. Impetigo Herpetiformis Complicating Pregnancy: A Case Report on a Rare Gestational Dermatosis With Constitutional Symptoms. Cureus 2023; 15:e47898. [PMID: 38034246 PMCID: PMC10683327 DOI: 10.7759/cureus.47898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/28/2023] [Indexed: 12/02/2023] Open
Abstract
Impetigo herpetiformis (IH) is a rare dermatosis that can manifest during the last trimester of pregnancy. It has the potential to cause fatality to both the mother and the fetus. After birth, it often vanishes spontaneously and rapidly. Clinically and histologically, it resembles pustular psoriasis, leading some authors to call it "the pustular psoriasis of pregnancy." Steroids were previously the treatment of choice, but treatment remains challenging. A dermatologist with experience in skin conditions during pregnancy should assess any generalized pustular psoriasis instances. There is a danger of stillbirth when a systemic sickness develops, so both the mother and fetus should be properly watched. A well-known side effect of pregnancy-related generalized pustular psoriasis is maternal sepsis. We report our own experience with a case of a 26-year-old pregnant woman who presented with IH that resolved postpartum.
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Affiliation(s)
- Ketav S Joshi
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shazia Mohammad
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neema Acharya
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Samir Joshi
- Obstetrics and Gynecology, Dr. Vinod Joshi Maternity Nursing Home, Mumbai, IND
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Abdelhafez MMA, Ahmed KAM, Mohd Daud MNB, Jeffree MS, Kadir F, Baharuddin DMP, Than WW, Hayatti F, Tay KX, Eldiastey AM. Impetigo herpetiformis: A rare pregnancy-specific dermatosis. Obstet Med 2023; 16:5-8. [PMID: 37139500 PMCID: PMC10150312 DOI: 10.1177/1753495x221074610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/18/2021] [Accepted: 01/02/2022] [Indexed: 11/15/2022] Open
Abstract
Impetigo herpetiformis (IH) is a pregnancy-specific dermatosis that is currently considered a form of generalised pustular psoriasis and mainly occurs in late pregnancy during the third trimester. IH presents as erythematous patches and pustules and might have systemic involvement. The disease may be associated with severe maternal, fetal, and neonatal complications. IH treatment is very challenging, however, various therapeutic options are available and effective for disease treatment.
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Affiliation(s)
- Mohsen M. A. Abdelhafez
- Department of Obstetrics and Gynaecology,
Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Karim A. M. Ahmed
- Department of Dermatology, Helios Saint Johannes Klinikum, Duisburg, Germany
| | - Mohd Nazri Bin Mohd Daud
- Family Medicine Unit, Department of Public
Health Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Mohammad Saffree Jeffree
- Department of Public Health Medicine, Faculty
of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Fairrul Kadir
- Department of Emergency Medicine, Faculty of
Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Dg Marshitah pg Baharuddin
- Department of Obstetrics and Gynaecology,
Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Win Win Than
- Department of Obstetrics and Gynaecology,
Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Firdaus Hayatti
- Department of Surgery, Faculty of Medicine
and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Kai Xin Tay
- Faculty of Business, Economic, and
Accountancy, Universiti Malaysia Sabah, Malaysia
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Mariem E, Emna B, Khadija S, Slaheddine M, Faiza F, Hamida T, Noura B. Pustular Psoriasis of Pregnancy: Clinical and Genetic Characteristics in a Series of 8 Patients and Review of the Literature. Dermatol Ther 2022; 35:e15593. [DOI: 10.1111/dth.15593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/05/2022] [Accepted: 05/19/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Ennouri Mariem
- Laboratory of Molecular and Functional Genetics, Faculty of Sciences of Sfax Sfax University TUNISIA
| | - Bahloul Emna
- Department of Dermatology, CHU Hedi Chaker, Sfax Sfax University TUNISIA
| | - Sellami Khadija
- Department of Dermatology, CHU Hedi Chaker, Sfax Sfax University TUNISIA
| | | | - Fakhfakh Faiza
- Laboratory of Molecular and Functional Genetics, Faculty of Sciences of Sfax Sfax University TUNISIA
| | - Turki Hamida
- Department of Dermatology, CHU Hedi Chaker, Sfax Sfax University TUNISIA
| | - Bougacha‐Elleuch Noura
- Laboratory of Molecular and Functional Genetics, Faculty of Sciences of Sfax Sfax University TUNISIA
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Liu J, Ali K, Lou H, Wang L, Wu L. First-Trimester Impetigo Herpetiformis Leads to Stillbirth: A Case Report. Dermatol Ther (Heidelb) 2022; 12:1271-1279. [PMID: 35499740 PMCID: PMC9059450 DOI: 10.1007/s13555-022-00735-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/13/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Pustular psoriasis of pregnancy (PPP), also known as impetigo herpetiformis (IH), is a rare variant of generalized pustular psoriasis (GPP) in pregnancy. It typically occurs in the third trimester and is a life-threatening condition for both the pregnant mother and the fetus if not diagnosed and treated promptly. Drug-induced PPP has been reported in sporadic case reports. Here we present a case of first-trimester PPP occurring after applying drugs including chloroquine, which we consider a possible culprit triggering the disease. Case report A 29-year-old female was admitted to our department at 45 days gestation with sudden onset of fever and widespread erythematous pustules for 9 days. She had been on medications including hydroxychloroquine before onset. The eruptions and systemic symptoms were controlled with high-dose systemic steroids; however, she was detected to have a stillbirth, and underwent dilation and curettage of the uterine. At the latest follow-up about 2 years after her admission, she reported to have delivered a healthy baby about 1 month previously. Conclusions Chloroquine has potential to lead to PPP in the first trimester of pregnancy. Further studies are warranted to investigate the etiology and treatment of PPP to facilitate early recognition and optimal management of this relatively rare dermatosis in pregnancy.
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Affiliation(s)
- Jue Liu
- Department of Dermatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, No. 261, Huansha Road, Hangzhou, China
| | - Kamran Ali
- Department of Dermatology, International Education College of Zhejiang, Chinese Medical University, Hangzhou, 310006, Zhejiang, China
| | - Haiyue Lou
- Department of Dermatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, No. 261, Huansha Road, Hangzhou, China
| | - Lingling Wang
- Department of Dermatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, No. 261, Huansha Road, Hangzhou, China
| | - Liming Wu
- Department of Dermatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, No. 261, Huansha Road, Hangzhou, China.
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Impetigo Herpetiformis: Review of Pathogenesis, Complication, and Treatment. Dermatol Res Pract 2018; 2018:5801280. [PMID: 29849579 PMCID: PMC5904797 DOI: 10.1155/2018/5801280] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 03/05/2018] [Indexed: 12/29/2022] Open
Abstract
Impetigo herpetiformis (IH) is among rare dermatosis of pregnancy, which is currently considered as a form of generalized pustular psoriasis. It is diagnosed by characteristic lesions of erythematous patches and grouped pustules mostly in the third trimester of pregnancy and may have systemic associations. A variety of complications have been reported in the course of IH. Treatment of IH can be quite challenging, and a number of treatment options have been reported to be effective for the management.
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Abstract
Pustular psoriasis of pregnancy (PPP) is a life-threatening condition for both the pregnant mother and fetus, and must be efficiently and accurately diagnosed and treated. This condition has historically been classified as a unique, separate dermatosis of pregnancy. However, current opinion and data suggest that it may be a variant of generalized pustular psoriasis. PPP typically occurs in the third trimester and is characterized by widespread coalescent pustules, desquamation, and systemic symptoms. Clinical features and histopathologic evaluation aid in diagnosis. Treatments during pregnancy include high-dose corticosteroids, cyclosporine, narrow-band ultraviolet B radiation, infliximab, granulocyte and monocyte adsorptive apheresis, and systemic antibiotics. Both the mother and fetus should be closely monitored with appropriate laboratory studies for the duration of the pregnancy and postpartum.
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Affiliation(s)
- Megha K Trivedi
- Department of Dermatology, University of California, San Francisco, CA, USA
- Medical School, University of Michigan, Ann Arbor, MI, USA
| | | | - Jenny E Murase
- Department of Dermatology, University of California, San Francisco, CA, USA
- Department of Dermatology, Palo Alto Medical Foundation, Palo Alto, CA, USA
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Anesthetic management for cesarean delivery of a parturient with impetigo herpetiformis. ACTA ACUST UNITED AC 2015; 1:14-6. [PMID: 25611605 DOI: 10.1097/acc.0b013e318291d219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Impetigo herpetiformis (IH), or generalized pustular psoriasis of pregnancy, is an exceedingly rare, generalized pustular skin eruption occurring during pregnancy associated with hypovolemia, sepsis, hypocalcemia, and airway edema. Fetal outcomes are generally poor, and parturients with IH may present with emergent indications for cesarean delivery due to placental insufficiency. We present a case of IH in a 19-year-old G1P0 who underwent successful general anesthesia for cesarean delivery. Her case highlights the anesthetic implications for patients afflicted with this rare disease, including perioperative pain management, airway concerns, considerations for neuraxial anesthesia, and monitoring challenges.
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Ulubay M, Keskin U, Fidan U, Çiçek AF, Çalışkan E, Karaca RE, Fıratlıgil FB, Ergün A. Case report of a rare dermatosis in pregnancy: Impetigo herpetiformis. J Obstet Gynaecol Res 2014; 41:301-3. [DOI: 10.1111/jog.12530] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 06/30/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Mustafa Ulubay
- Department of Obstetrics and Gynecology; Gulhane Military Medical Academy; Ankara Turkey
| | - Uğur Keskin
- Department of Obstetrics and Gynecology; Gulhane Military Medical Academy; Ankara Turkey
| | - Ulas Fidan
- Department of Obstetrics and Gynecology; Gulhane Military Medical Academy; Ankara Turkey
| | - Ali Fuat Çiçek
- Department of Pathology; Gulhane Military Medical Academy; Ankara Turkey
| | - Ercan Çalışkan
- Department of Dermatology; Gulhane Military Medical Academy; Ankara Turkey
| | - Rıza Efendi Karaca
- Department of Obstetrics and Gynecology; Gulhane Military Medical Academy; Ankara Turkey
| | | | - Ali Ergün
- Department of Obstetrics and Gynecology; Gulhane Military Medical Academy; Ankara Turkey
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Gao QQ, Xi MR, Yao Q. Impetigo Herpetiformis during Pregnancy: A Case Report and Literature Review. Dermatology 2013; 226:35-40. [DOI: 10.1159/000346578] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 12/09/2012] [Indexed: 11/19/2022] Open
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