Generalized pustular psoriasis of pregnancy treated with infliximab

Sheth, Niral K; Greenblatt, D. J.; Acland, K.; Barker, Jonathan; Teixeira, Fábio Vieira

doi:10.1111/j.1365-2230.2008.02963.x

Cited by 30 publications

(24 citation statements)

References 7 publications

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“…Impetigo herpetiformis is a dermatosis of pregnancy that may persist beyond delivery, carries an increased risk of stillbirths and fetal abnormalities, and has been reported to respond to infliximab treatment after 2 pregnancies in a patient who decided to terminate her unwanted second pregnancy because of concerns about the evolution of her disease [5]. In our patient, the antecedent of pustular psoriasis during pregnancy and lack of response of her psoriasis to systemic treatment justified the decision to start infliximab therapy.…”

Section: Discussionmentioning

confidence: 88%

Treatment of Psoriasis with Anti-TNF Drugs during Pregnancy: Case Report and Review of the Literature

2009

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Published experiences of TNF-α inhibition during pregnancy consist of a limited number of case reports, series and ongoing registry data in patients with arthritis and inflammatory bowel disease. A 28-year-old woman – with psoriasis vulgaris since she was 8 years of age and generalized pustular psoriasis during her first pregnancy (partially controlled with ciclosporin, oral prednisone and topical corticosteroids, when lupus anticoagulant was detected at another hospital) – presented 4 months after delivery with severe psoriasis (PASI = 15.4) that did not respond to ciclosporin (3 mg/kg/day). Ten days after the first infusion of infliximab (5 mg/kg), when the patient became aware that she was pregnant again, there was PASI75 response, and the patient wished to continue this treatment after being fully informed. Complete blanching was achieved by week 6 of treatment, and was maintained thereafter until the moment of writing (19 months after the start of treatment). She gave birth by caesarean delivery to a healthy female baby, who was breastfed for 1 month and has developed normally. The current report extends the available evidence on successful infliximab treatment in pregnant women, with the first case of a patient with psoriasis who presented impetigo herpetiformis during her previous pregnancy. No detectable adverse effects were detected in the neonate, despite potential exposure to infliximab throughout gestation and breastfeeding. Even though absolute safety is difficult to prove, available data suggest that women who become pregnant while taking infliximab or other anti-TNFα agents can be reassured regarding the continuation of pregnancy.

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Section: Discussionmentioning

confidence: 88%

Treatment of Psoriasis with Anti-TNF Drugs during Pregnancy: Case Report and Review of the Literature

2009

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“…Cyclosporine has been administered in 13 patients with IH in the literature [6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17]. Reviewing the above-mentioned cases, in 12 out of 14 cases, including ours, cyclosporine was not used as a monotherapy in the treatment of IH but in combination with systemic corticosteroids (table 1).…”

Section: Discussionmentioning

confidence: 99%

“…Use of the lowest active dose and careful monitoring of the fetus is advisable, though, as there is still a weak possibility of early rupture of the membranes [18]. In the majority of IH cases, total regression of lesions must be expected after delivery and moreover, if there is persistence, with an alternative regimen, such as methotrexate [19] or infliximab [16]. In our patient, 3 weeks after cesarean section, methotrexate at a dose of 15 mg subcutaneously was proposed, resulting in a complete clearance.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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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.

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“…New lesion eruption ceased within 5 days of cyclosporine treatment; after 5 weeks of treatment, the dosage was decreased to 200 mg daily, at which point almost 90% of the skin lesions had cleared [11]. Sheth et al [12] presented a case of IH who responded to infliximab treatment. Although its absolute safety is difficult to prove, Puig et al [13] reviewed pregnancy outcomes of 219 cases who had been exposed to tumor necrosis factor antagonists and concluded that women who conceived while taking infliximab or other anti-tumor-necrosis-factor-α agents can be reassured regarding the continuation of pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Impetigo Herpetiformis with Gestational Hypertension: A Case Report and Literature Review

et al. 2011

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Background: Impetigo herpetiformis (IH) is a rare skin disorder that occurs during pregnancy. It was previously associated with high maternal and fetal mortality and morbidity, but now has a better prognosis. Case Report: We report a case of a pregnant woman with IH who presented with generalized erythematous pustular eruptions in the 32nd week of gestation. The IH progressed rapidly, and gestational hypertension was observed in the 36th week. The lesions did not subside, despite treatment with corticosteroids and phototherapy. She delivered a healthy male baby via cesarean section in the 37th week. One month after her delivery, her skin returned to normal, except for residual pigmentation, with complete recovery 3 months postpartum. Conclusion: An experienced medical team comprising obstetricians, dermatologists, perinatologists and neonatologists is critical to aggressively treat this life-threatening specific dermatosis of pregnancy and to prevent ensuing complications, such as fluid and electrolyte imbalance, secondary infection and placental insufficiency.

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Generalized pustular psoriasis of pregnancy treated with infliximab

Cited by 30 publications

References 7 publications

Treatment of Psoriasis with Anti-TNF Drugs during Pregnancy: Case Report and Review of the Literature

Treatment of Psoriasis with Anti-TNF Drugs during Pregnancy: Case Report and Review of the Literature

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

Impetigo Herpetiformis with Gestational Hypertension: A Case Report and Literature Review

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