Cyclosporine in the Management of Impetigo Herpetiformis: A Case Report and Review of the Literature

Abstract

A 27-year-old female, gravida 1, para 0, in week 22 of pregnancy, presented with an eruption consisting of annular erythematosquamous plaques with an active polycyclic elevated border comprised of superficial micropustules. Clinical and histological features were typical of impetigo herpetiformis (IH). Systemic steroids resulted in an unstable condition, with no resolution of lesions. Resistance to the above therapeutic scheme served as a stimulus to discuss the use of cyclosporine as a therapeutic option in this condition. Reviewing the limited literature, cyclosporine seems to serve not as a monotherapy in the management of IH but as an additional medication, in order to achieve a stable course of the disease and avoid high doses of systemic steroids.

Generalized pustular psoriasis: a review and update on treatment

“…The dermis is characterized by dilated blood vessels with fewer neutrophils. In contrast to GPP, APP may have subcorneal pustules, and PPPP usually has eosinophils and mast cells in the upper dermis …”

“…Of note, steroids have been associated with macrosomia, gestational diabetes and premature rupture of membranes. Cyclosporine undergoes placental transfer and has been associated with early rupture of membranes . Topical corticosteroids and calcipotriene are second‐line treatment for less severe cases.…”

“…In contrast to GPP, APP may have subcorneal pustules, and PPPP usually has eosinophils and mast cells in the upper dermis. 18,37,61,62 Treatment A number of factors need to be considered when deciding treatment. Options are summarized in Table 3.…”

Inflammatory and glandular skin disease in pregnancy

“…IH is generally responsive to systemic corticosteroids 20,21,24. In cases that do not respond to systemic corticosteroids, cyclosporine and nbUVB can be used 25,26. Induction of labor has been reported as a treatment method in recalcitrant cases, especially if the patient is near or at term 22,23.…”

“…Although IH usually remits soon after delivery,21,24 lesions can persist up to 2 months postpartum 22,23. After delivery, acitretin and methotrexate have been used successfully in non-lactating mothers 23,26. …”