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

Abstract

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.

Impetigo Herpetiformis during Pregnancy: A Case Report and Literature Review

“…Some cases report that IH may be complicated by gestational hypertension, fetal distress because of placental insufficiency, hypoparathyroidism, hyperparathyroidism, diabetes or hypoalbuminemia [8,9,11,22,23]. …”

“…According to the literature review, the treatments of IH mainly include systemic corticosteroids (prednisone), cyclosporine, antibiotic, methotrexate, ultraviolet A (PUVA), system retinoids and clofazimine [2,7,8,9,10,11,12,17,18,22,23,24]. At the beginning of IH or in mild cases, corticosteroids are usually efficacious at a low dose of 15-30 mg a day.…”

“…At the beginning of IH or in mild cases, corticosteroids are usually efficacious at a low dose of 15-30 mg a day. In some severe cases, it is necessary to increase the dose to 40-60 mg a day to control the symptoms [2,22]. However, some cases reported that the patients were unresponsive to corticosteroid therapy [10,17,22].…”

“…In some severe cases, it is necessary to increase the dose to 40-60 mg a day to control the symptoms [2,22]. However, some cases reported that the patients were unresponsive to corticosteroid therapy [10,17,22]. In progressive cases, oral cyclosporine is the second-line therapy for IH and antibiotics should be administered to treat or prevent secondary infection [2,9,17,22].…”

“…However, some cases reported that the patients were unresponsive to corticosteroid therapy [10,17,22]. In progressive cases, oral cyclosporine is the second-line therapy for IH and antibiotics should be administered to treat or prevent secondary infection [2,9,17,22]. Furthermore, it is reported that taking parenteral calcium, vitamin D, infliximab and pyridoxine in high doses, as well as chorionic gonadotropin, is effective for IH during pregnancy.…”