ABSTRACT
Impetigo herpetiformis, also known as generalized pustular psoriasis of pregnancy, is generally considered as a rare subtype of pustular psoriasis that occurs during pregnancy. Current treatment includes systemic and topical glucocorticoids, cyclosporine, biologic agents, antibiotics, phototherapy, granulocyte and monocyte apheresis, etc. This review summarizes treatment strategies for impetigo herpetiformis.
ABSTRACT
Impetigo herpetiformis or pustular psoriasis of pregnancy is a rare dermatosis of pregnancy that typically starts in the secondhalf of pregnancy and resolves postpartum. It can be life threatening for both mother and fetus and often causes therapeutic problem. We report a case of 37-year-old pregnant woman with history of generalized pustular lesions in the twoprevious pregnancies, presenting an impetigo herpetiformis during her third pregnancy, resolved one day after the delivery
ABSTRACT
@#Introduction: Impetigo herpetiformis is a rare pustular disorder that affects pregnant women. It is also otherwise termed as “pustular psoriasis of pregnancy”, owing to the fact that the pustules are sterile and are not associated with a viral etiology. The classic lesions are erythematous patches or plaques with margins studded with subcorneal pustules spreading centrifugally. A cardinal feature of this disorder is the rapid resolution of lesions after delivery. Case Summary: This is a case report of a 33-year-old female, gravida 3, para 2 (2-0-0-2) at 36 weeks age of gestation who presented with one week history of multiple well defined irregularly shaped erythematous annular patches and plaques with marginal pustules on the trunk and extremities. The lesions began on the trunk spreading centrifugally, sparing the face, palms, soles and mucus membrane. Biopsy showed scale crust in the stratum corneum, the epidermis showed acanthosis, spongiosis and neutrophilic microabscesses with focal vacuolar alteration and small sub-epidermal nests on the basal cell layer. The dermis revealed dilated blood vessels and mild superficial perivascular lymphocytic infiltrates. Patient was given Prednisone and Cetirizine with noted resolution of lesions. Conclusion: Recurrences of impetigo herpetiformis in subsequent pregnancies are common with earlier onset in gestation and are characteristically more severe. The complications are placental insufficiency, stillbirth or neonatal death. Early detection is of utmost importance. Management must be multidisciplinary involving a dermatologist, obstetrician and pediatrician.
Subject(s)
Pregnancy , Female , Impetigo , Psoriasis , Skin Diseases, Vesiculobullous , ExanthemaABSTRACT
Impetigo herpetiformis (IH) is an extremely rare pustular dermatosis of pregnancy with typical onset during the second or third trimester of pregnancy and generally rapid resolution after delivery. Recurrent case of IH in subsequent pregnancy tend to earlier onset and greater severity. We report a 33-year-old pregnant woman, with a history of mild IH in the first pregnancy, who presented with generalized lesions at nearly 29 weeks' gestation. Her condition had become worse suddenly at 34 weeks' gestation. She developed fever, small for gestational age, and gait disturbance due to ache in both thighs. So we decided to terminate the pregnancy by repeat cesarean section. After delivery, her skin lesions had worsen rapidly in spite of treatment with corticosteroids. So she was treated with a large dose of acitretin. Three months after her delivery, her skin was returned to original state, except for residual pigmentation. In conclusion, our case indicates that clinicians should be aware of the possibility of sudden deterioration of the maternal lesions and fetal condition associated with IH.
Subject(s)
Adult , Female , Humans , Pregnancy , Acitretin , Adrenal Cortex Hormones , Cesarean Section, Repeat , Fever , Gait , Gestational Age , Impetigo , Pigmentation , Pregnancy Trimester, Third , Pregnant Women , Skin , Skin Diseases , ThighABSTRACT
Impetigo herpetiformis is a rare and acute pustular eruption that is often accompanied by fever and leukocytosis, which occurs during the 3rd trimester of pregnancy and usually resolves after delivery. In general, impetigo herpetiformis is regarded as a variant of psoriasis that has histopathologic features of pustular psoriasis. The lesions typically begin in the flexural areas, but rarely involve the mucous membranes. The face, palms, and soles are commonly spared. However, we report a 29-year-old woman with impetigo herpetiformis showing mucosal, face and palm involvement, atypical skin manifestation.
Subject(s)
Female , Humans , Pregnancy , Fever , Impetigo , Leukocytosis , Mucous Membrane , Psoriasis , Skin , Skin ManifestationsABSTRACT
Impetigo herpetiformis is a rare, severe dermatologic disorder that is similar to a type of pustular psoriasis that predominantly occurs during the 3rd trimester of pregnancy. This condition usually resolves after delivery and it rarely continues until the postpartum period. Systemic corticosteroids have proven to be the drug of choice for the management of impetigo herpetiformis. In the postpartum period, oral retinoids such as isotretinoin, etretinate and acitretin can be used to control impetigo herpetiformis, but their side effect such as teratogenicity is a big issue to women of child-bearing age. We report here on a case of impetigo herpetiformis in a 28-year-old woman who did not respond to oral corticosteroids, but she was treated successfully with cyclosporine. To the best of our knowledge this is the first case of impetigo herpetiformis treated with cyclosporine in the Korean medical literature.
Subject(s)
Adult , Female , Humans , Pregnancy , Acitretin , Adrenal Cortex Hormones , Cyclosporine , Etretinate , Impetigo , Isotretinoin , Postpartum Period , Psoriasis , RetinoidsABSTRACT
El impétigo herpetiforme es una rara dermatosis pustular no infecciosa que se presenta en el embarazo especialmente en el último trimestre. Describimos el caso de una gestante primigesta, de 21 años quien presentó en el último trimestre compromiso cutáneo, que inicia en palma de manos, antebrazo, miembros inferiores y abdomen, tratado con prednisona a 30 mg/dia con buena evolución tanto para la madre y el producto Se presenta el caso por ser inusual y se revisa la literatura.
Impetigo herpetiformis is a rare non-infectious pustular dermatosis that occurs in pregnancy, especially in the last quarter. We describe the case of a pregnant primigravida, aged 21 who presented in the last quarter cutaneou sinvolvement, which began in palm of hands, forearms, lower limbs and abdomen, treated with prednisone at 30 mg / day with a good outcomefor both mother and the product.
Subject(s)
Humans , Adult , Female , Pregnancy , Skin Diseases , Impetigo , Prednisone/therapeutic useABSTRACT
Two multigravidae aged 27 and 29 years, with previous uneventful pregnancies, second being psoriatic, reported at 24 and 28 weeks of pregnancies, with generalized pustular lesions. Laboratory findings, including serum calcium were normal. Ultrasonography showed normal fetal growth. Histopathology confirmed pustular psoriasis. Patients were put on cyclosporine 3 mg/ kg weight/ day after failure of an initial systemic steroid. Blood pressure, pulse, and fetal heart sounds were recorded every 12 hours, and ultrasonography and blood parameters, biweekly. Cyclosporine was tapered and stopped after delivery of two healthy babies at 38 weeks. We conclude that cyclosporine can be an option in the management of pustular psoriasis of pregnancy or psoriasis with pustulation in pregnancy.
ABSTRACT
Generalized pustular psoriasis of pregnancy (GPPP) is a rare form of pustular psoriasis that occurs in pregnant women during the third trimester. It is characterized by erythematous plaques, peripheral scale and sterile pustules, and this malady is associated with systemic symptoms such as fever, malaise, diarrhea and pain. A 34-year-old primigravida woman with an intermittent history of plaque psoriasis for 12 years presented with a two week history of increasingly widespread erythematous eruptions and associated peripheral pustules. The histopathologic findings were consistent with pustular psoriasis. She was diagnosed with generalized pustular psoriasis of pregnancy and she was treated with systemic and topical steroid, narrowband ultraviolet B phototherapy and wet dressings. 2 weeks after treatment, the patient demonstrated clinical and symptomatic improvement.
Subject(s)
Adult , Female , Humans , Pregnancy , Bandages , Diarrhea , Fever , Phototherapy , Pregnancy Trimester, Third , Pregnant Women , PsoriasisABSTRACT
Impetigo herpetiformis is a rare pustular disorder that primarily affects pregnant women. A 31 year-old woman at 37 weeks and 4 days' gestation of 3rd pregnancy presented with pruritic multiple erythematous pustules and crusts on the trunk and both antecubital fossa for 3 months. She had had similar lesions in her 1st and 2nd pregnancy, which subsided after delivery without any fetal or maternal complication. She had no personal or familial history of psoriasis. Histopathologic findings showed subcorneal pustules with numerous neutrophils and spongiform pustule of Kogoj. Bacterial culture from pustules was sterile. After Caesarean section at 38 weeks' gestation, a healthy female neonate was delivered and her skin lesion resolved spontaneously.
Subject(s)
Female , Humans , Infant, Newborn , Pregnancy , Cesarean Section , Impetigo , Neutrophils , Pregnant Women , Psoriasis , SkinABSTRACT
Impetigo herpetiformis is a rare, severe dermatologic disorder occurring predominantly in the third trimester of pregnancy. Rarely, it may present during the puerperium, and this suggests that impetigo herpetiformis should be included in the differential diagnosis of puerperal fever, particularly in those cases associated with dermatoses. We report a 32-year-old woman who developed impetigo hermpetiformis during puerperium. She was a primigravida and did not have a previous history of psoriasis. Three days after parturition she developed a severely pruritic pustular rash composed of erythematous patches first presented in both axilla. The patient showed rapid improvement with oral prednisolone 40 mg/day for 5 days, and the lesions healed in 10 days. Follow-up for 12 months revealed no recurrence.
Subject(s)
Adult , Female , Humans , Pregnancy , Axilla , Diagnosis, Differential , Exanthema , Fever , Follow-Up Studies , Impetigo , Parturition , Postpartum Period , Prednisolone , Pregnancy Trimester, Third , Psoriasis , Recurrence , Skin DiseasesABSTRACT
Impetigo herpetiformis is a rare pustular eruption that may be seen in late pregnancy. It is associated with severe maternal and fetal complications in case of misdiagnosis and delayed treatment. The patient was a 25-years-old multigravida with psoriasis in her past history. At 20weeks gestation, she had been developed erythematous scaly annular patchs with papules and pustules on inner thigh. At 37weeks' gestation, the patient was suffered from a severely pruritic pustular rash with fever and leukocytosis. The skin of the affected areas was biopsied and showed intraepidermal pustular abscess with a neutrophilic infiltrate. Treatment commenced with intravenous fluids, antibiotics, systemic prednisone, steroid creams, and phototherapy(UVB) under the careful fetal well being monitoring. Cesarean section was done due to fetal distress, and a normal healthy male infant was delivered, following which the patient's condition improved rapidly.
Subject(s)
Female , Humans , Infant , Male , Pregnancy , Abscess , Anti-Bacterial Agents , Cesarean Section , Diagnostic Errors , Exanthema , Fetal Distress , Fever , Impetigo , Leukocytosis , Neutrophils , Prednisone , Psoriasis , Skin , ThighABSTRACT
A case of impetigo herpetiformis occurring in a 25-year-old multigravida woman is reported. Superficial grouped pustules on an erythematous base developed on the flexual areas of both extremities and disseminated all over the body with mild pruritus, fever and burning sensation at her 14th weeks of pregnancy. Histopathologic findings showed acanthosis and subcorneal. pogiform pustule. All lesions had gradually improved within 2 weeks after artificial abortior. Our case demonstrates the characteristic features of impetigo erpetiformis, as compared with pustular psoriasis. This, we emphasize the need to preserve it as a separate entity.
Subject(s)
Adult , Female , Humans , Pregnancy , Burns , Extremities , Fever , Impetigo , Pruritus , Psoriasis , SensationABSTRACT
We present a case of impetigo herpetiformis occurring in a 20-year-old primigravida who developed severe cutsneous lesion which was characterized by groups of small, sterile pustules on an inflamed base and was associated with fever, chill, and malaise. Histopathologic findings showed acute inflammatory reaction with spongiform pustule of Kogoj in the upper epidermis and microabscess within the horny layer, Antibiotics and steroids treatment even aggravated the disease. After delivery, she was given oral retinoid(Tigason ), and consequently the skin lesions cleared in (i weeks.