Personal treatment experience for severe generalized pustular psoriasis of pregnancy: two case reports

Abstract

Generalized pustular psoriasis of pregnancy (GPPP) is a rare and severe variant of pustular psoriasis. It has been called the most dangerous and life-threatening dermatosis in pregnant woman. To explore the treatment of GPPP, we conducted a retrospective study of two cases of GPPP in our clinic and other related reported cases and manuscripts. In 1992, a GPPP patient came to our clinic. We prescribed her antibiotics and dexamethasone. The pregnancy was artificially terminated. After delivery, she took a retinoid and a topical steroid and recovered progressively. In 2012, we treated another GPPP patient. Methylprednisolone and cyclosporine were administered. Maternal and fetal statuses were monitored closely. The treatment was effective and a healthy baby was delivered. We compared our two GPPP cases and found that cyclosporine and a sufficient dosage of steroid were an effective treatment. Antibiotics could be tried in mild cases or the initial stages before excluding sepsis. Based on other reported GPPP cases, TNF-α antagonists are used as rescue therapy in GPPP refractory to steroid and cyclosporine therapy, but careful consideration of the advantages and disadvantages is warranted before using them. Supportive measures are necessary to maintain pregnancy and prevent complications in cases of GPPP.

Treatment resistant impetigo herpetiformis treated with infliximab

“…It is considered the first‐line treatment of the disease during pregnancy (Wamalwa, ). Cyclosporin may be added to the treatment in refractory cases (Luan, Han, Zhang, & Liu, ). Additionally, some steroid resistant recurrent IH cases, which were treated subsequently with methotrexat, acitretin, or UVB therapy have been reported (Cravo, Vieira, Tellechea, & Figueiredo, ).…”

Generalized pustular psoriasis: a review and update on treatment

“…In pregnancy, GPP is also known as impetigo herpetiformis . It has been called the most dangerous dermatologic condition in pregnancy because of both maternal and fetal morbidity . It usually presents during the third trimester and resolves in the postpartum period.…”

“…9 It has been called the most dangerous dermatologic condition in pregnancy because of both maternal and fetal morbidity. 10 It usually presents during the third trimester and resolves in the postpartum period. However, it may relapse during the first menstruation after delivery.…”

Dermatoses of pregnancy: Nomenclature, misnomers, and myths

“…1 A potential fifth dermatosis, pustular psoriasis of pregnancy (PPP), was formerly part of the original categorization of the dermatoses of pregnancy but was dropped from the scheme by (Table 2); 2 however, some authors still consider PPP as another disease within the current scheme. 1,3,4 The nomenclature and classification system of these pregnancyspecific eruptions, particularly PEP, AEP, and PPP, have been revised several times, generating potential confusion among practitioners. Generating further confusion are several misnomers, historic and modern, that have been used to describe dermatoses of pregnancy.…”

“…In this contribution, we describe how the original nomenclature of each dermatosis of pregnancy has been modified to fit the current day classification scheme. We then A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT 4 identify several misnomers that have generated confusion within the scheme. Finally, we present the historical perspectives of myths that have developed around cutaneous conditions that are not included in specific dermatoses.…”