Pustular psoriasis of pregnancy: Treatment and Precautions

Pustular Psoriasis of Pregnancy: Why does it happen?

pregnancy pustular psoriasis
Photo by Alicia Petresc on Unsplash

Impetigo herpetiformis also is known as Pustular psoriasis of pregnancy. (1)

  • includes but not limited to rash, pruritus, edematous pink plaques, collarettes of scaling, macules on palm, trunk and proximities along with desquamation of skin
  • It may be localized or may be widespread
  • Be cautious in pregnancy if skin eruptions are spreading
  • treatment with antibiotics and systemic steroids may help under close physician care.
  • The risk to the fetus is unpredictable hence critical care must be ensured
Pustular psoriasis of pregnancy
Source: MDedge Dermatology

Pustular Psoriasis of Pregnancy: Why does it happen?

The exact cause is unknown. Some researches states decreased calcium in the blood and decreased parathyroid activity has been proposed.

More research is required in hormonal contraception, stress, a bacterial disease, seasonal change and certain medicines (activated charcoal, potassium iodide and salicylates), is controversial.

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What are the Risks of Pustular Psoriasis?

It was first reported by von Hebra et al, in women manifested as pustular lesions, inflammatory and crust formating eruptions. (2)

It generally occurs during the last trimester of pregnancy and rapid resolution in the postpartum period.

  • More similar to pustular psoriasis.
  • Most cases resolution in the postpartum period
  • More risk of stillbirths, 
  • Maternal serious risks are rare

Clinical examination of Pustular psoriasis

Lesions in a skin fold, with centrifugal spread, in some cases affecting the entire skin surface. There may be poor general condition, fever, diarrhoea, dehydration, tachycardia and seizures.

The following laboratory findings stand out: leukocytosis, increased ESR and negative bacterial culture of pustules and peripheral blood. Levels of calcium, phosphate and albumin may be reduced. The diagnosis is suggested by PPG clinical and laboratory elements and is predominantly confirmed by a predominantly neutrophilic inflammatory infiltrate, epidermal acanthosis and papillomatosis with focal parakeratosis, upon histological examination.

There are neutrophils collections, forming intraepidermal multilocular microabscesses, called spongiform pustules of Kogoj

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Lab tests of Pustular psoriasis

Biopsy generally required to establish tissue histology pustules are sterile and do not present viral aetiology.

There may be an absence of a personal and medical history of psoriasis; generally, resolve after delivery; and recur in following pregnancies. There are, however, records of individual and familial psoriasis cases and non-complete regression of lesions after delivery as well.

Treatment of Pustular psoriasis

There are no standard guidelines for the management of impetigo herpetiformis. Treatment may include prednisone 40mg/day, analgesics (oral paracetamol 1g thrice daily for 5 days) and prophylactic antibiotics (oral flucloxacillin 500mg four times daily for 5 days). Betason ointment 0.1% can be applied to the lesion twice daily. Supportive care with intravenous fluids and psychosocial support improve the outcome during admission. Prednisone dose can be reduced based on the improvement until delivery. Commonly lesions resolve one month postpartum. No further rebound or relapses occur after the resolution of the lesions.


Successful treatment with cyclosporine has been reported and this regime can be used as second-line treatment. Antibiotics may be used to prevent and treat infections. It is reported that taking parenteral calcium, vitamin D, infliximab and pyridoxine in high doses, as well as chorionic gonadotropin, is effective for impetigo herpetiformis during pregnancy.

Often, the lesions do not occur in the first pregnancy. however, appears in successive pregnancies which mostly recovered itself in one month.

 

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