Pustular psoriasis of pregnancy (Impetigo herpetiformis) - case report / Psoriase pustulosa da gestacao (Impetigo herpetiforme) - relato de caso

Impetigo herpetiformis is a rare dermatosis of pregnancy with typical onset during the last trimester of pregnancy and rapid resolution in the postpartum period. Clinically and histologically, it is consistent with pustular psoriasis. This similarity has led some authors to name the disease "the pustular psoriasis of pregnancy". We report the case of a patient who developed impetigo herpetiformis in two sucessive pregnancies.

Impetigo herpetiforme é uma dermatose gestacional rara que se inicia tipicamente durante o último trimestre e evolui com rápida resolução no período pós-parto. Clinica e histologicamente é consistente com psoríase pustulosa. Essa similaridade tem levado alguns autores a nomearem a doença como "psoríase pustulosa da gestação". Relatamos o caso de uma paciente que apresentou impetigo herpetiforme em duas gestações subsequentes.

Review: dermatitis herpetiformis / Revisao: dermatite herpetiforme

Dermatitis herpetiformis (DH) or Duhring-Brocq disease is a chronic bullous disease characterized by intense itching and burning sensation in the erythematous papules and urticarial plaques, grouped vesicles with centrifuge growth, and tense blisters. There is an association with the genotypes HLA DR3, HLA DQw2, found in 80-90% of cases. It is an IgA-mediated cutaneous disease, with immunoglobulin A deposits appearing in a granular pattern at the top of the dermal papilla in the sublamina densa area of the basement membrane, which is present both in affected skin and healthy skin. The same protein IgA1 with J chain is found in the small intestinal mucosa in patients with adult celiac disease, suggesting a strong association with DH. Specific antibodies such as antiendomysium, antireticulina, antigliadin and, recently identified, the epidermal and tissue transglutaminase subtypes, as well as increased zonulin production, are common to both conditions, along with gluten-sensitive enteropathy and DH. Autoimmune diseases present higher levels of prevalence, such as thyroid (5-11%), pernicious anemia (1-3%), type 1 diabetes (1-2%) and collagen tissue disease. The chosen treatment is dapsone and a gluten-free diet.

Dermatite herpetiforme é uma doença bolhosa crônica caracterizada por intenso prurido e sensação de queimação em pápulas eritematosas e placas urticariformes, vesículas agrupadas com crescimento centrífugo e bolhas tensas. Apresenta associação com genótipos de HLA DR3, HLA DQW2 encontrados em 80 a 90% dos casos. É uma doença cutânea mediada por IgA com depósito de imunoglobulina A em padrão granular no topo da papila dérmica na área da sublâmina densa na zona da membrana basal, presente tanto na pele lesada com em área de pele sã. A mesma cadeia J da proteína IgA1 é encontrada na mucosa do intestino delgado em pacientes com doença celíaca do adulto, sugerindo forte associação com a dermatite herpetiforme. Anticorpos específicos com anti-endomísio, anti-reculina, anti-gliadina, e recentemente identificado, o subtipo transglutaminase epidérmica e tecidual, assim como a produção aumentada da zonulina, são descritas em ambas as afecções enteropatia sensível ao glúten e a deramtite herpetiforme. Exibe depósitos de IgA em padrão granular na papila dérmica. Doenças auto-imunes exibem maior prevalência como tireoidopatia em 5 a 11%, anemia perniciosa em 1 a 3%, diabetes tipo 1 em 1 a 2% e doença do colágeno. O tratamento de escolha é a dapsona e dieta isenta de glútem.

Dermatitis herpetiformis and rheumatoid arthritis

Dermatitis herpetiformis DH is a rare, intensely pruritic, chronic, recurrent, papulovesicular disease. The disease can be clearly distinguished from the other subepidermal blistering eruptions by histologic, immunologic, and gastrointestinal criteria. Most patients have an associated gluten-sensitive enteropathy GSE that is usually asymptomatic. Both enteropathy and the dermatologic findings disappear with a gluten-free diet, therefore, DH is thought to be the specific dermatologic finding of celiac disease CD. An association between CD and autoimmune disease has been documented in several studies. Similar associations have been reported in DH. We report a 46-year-old man with DH diagnosed more than 10 years previously who developed GSE, pernicious anemia, and rheumatoid arthritis in the following years

Impétigo herpetiforme recurrente: manejo exitoso con ciclosporina / Recurrent impetigo herpetiformis: Successfully managed with ciclosporine. Report of one case

Impetigo Herpetiformis is a high-risk gestational skin disease that represents a risk for both the mother and offspring. Its management is based on multisystemic support and maternal steroid therapy. When these measures are insufficient to control the disease, the association of ciclosporine to the treatment has been proposed. We report a 24 year-old woman with a 16 weeks pregnancy, that presented with Impetigo Herpetiformis. The disease was refractory to the use of steroids, the patient had a metabolic decompensation and a dehydration with electrolyte imbalance. Therefore, treatment with ciclosporine was initiated and a rapid regression of the lesions was observed. Gestation was maintained, with a good perinatal outcome.

Association of bullous pemphigoid and dermatitis herpetiformis: a case report

A 21-year-old black man presented itching, symmetric, tense bullae on trunk, extremities and face with residual pigmentation. The histopathological findings included subepidermal bulla and inflammatory infiltrate with eosinophils and neutrophils. On immunofluorescence, a linear pattern of IgG, Ig A and C3 deposition was observed. The patient improved with oral sulfone (100 mg daily). As the case shares clinical, histopathological and immunofluorescence findings of both diseases, it was considered an association of bullous pemphigoid and dermatitis herpetiformis.