Impetigo herpetiformis or gestational pustular psoriasis can account for 4. weeks
May 1, 2017
Impetigo herpetiformis or gestational pustular psoriasis can account for 4. weeks and delivered a healthy male infant. Impetigo herpetiformis can be treated first line with topical and oral steroids and supportive measures but BI6727 immunomodulatory therapies such as cyclosporine have shown success in treating resistant cases. Background Impetigo herpetiformis or gestational pustular psoriasis or is a rare non-infectious dermatosis related to pregnancy which normally occurs during the third trimester of pregnancy but well documented cases have occurred as early as the first trimester.1 Primiparous women are at the highest risk though severity increases in subsequent pregnancies.2 It presents superficial pustules in an herpetiform distribution.3 The pustular eruption typically starts symmetrically in the axillae or groin flexures below the breasts or around the umbilicus sometimes in abdominal striae 4 but can extend to become generalised with desquamation with mucous membranes being only infrequently affected.5 The condition differs from other pregnancy dermatoses in that it can be associated with constitutional BI6727 symptoms including fever rigors gastrointestinal upset malaise and arthralgia.6-8 There are less than 200 reported cases9 which means that pathogenesis is not fully understood though the trigger may be maternal hypocalcaemia which can lead to serious maternal complications of confusion tetany and death 6 high progesterone levels or an infectious cause.10 Other complications include fluid and electrolyte imbalance and maternal secondary infection and sepsis.5 Fetal concerns include placental insufficiency even when the disease is controlled in the mother and an increased stillbirth risk11 and fetal abnormalities.3 5 8 Lesions are expected to regress after delivery but may reoccur at times of stress and at an earlier gestational age in further pregnancies 2 as a characteristic eruption of erythematosquamous plaques covered with small or confluent Case presentation A 25-year-old woman was referred at 31 weeks gestation systemically unwell with a widespread erythematous rash. She initially presented to her general practitioner at 7 weeks gestation with a peri-umbilical rash which was non-responsive to topical steroid preparations (trimovate dermovate) causing pain not pruritis. On admission she was feverish at over 38°C and tachycardic with an erythematous rash covering most of the body surface with confluent blisters and desquamation having severe pain in all areas affected by the rash (figure 1). Figure 1 BI6727 Impetigo herpetiformis occurring over (A) abdomen (B) flexure (C) lower limb and (D) foot. Her obstetric history was gravida 2 para 1 with a previous uncomplicated pregnancy and normal vaginal delivery of a term 3520 g female infant 6 years previously. Her medical history included mild asthma requiring salbutamol fluticasone and salmeterol inhalers for control. Investigations Initial investigations showed a negative septic screen; blood cultures and swabs from the rash and pustules showed no growth. Her total calcium and albumin were low albumin with a raised erythrocyte sedimentation rate Rabbit polyclonal to DUSP3. (ESR) and C reactive protein and neutrophilia other results were within normal limits. Serum autoantibody screens including antipemphigoid autoantibodies were negative and the skin biopsy was negative for IgM IgG IgA C3 and fibrinogen supporting a diagnosis of impetigo herpetiformis.10 Treatment Five days of increasing oral steroid therapy to a maximum of 80 mg prednisolone daily12 failed to control symptoms so cyclosporine was commenced and the steroid dosage was tapered over the following 14 days. A dose of 200 mg BI6727 cyclosporine twice daily achieved symptom control after 9 days. During this period the patient had been requiring regular opioid-based analgesia for symptomatic relief. Outcome and follow-up She was monitored intensely throughout BI6727 the remainder of her pregnancy and went into spontaneous labour at 41+2 weeks rupturing membranes during labour with a normal vaginal delivery of a 3200 g male infant. He required no.