Recurrent impetigo herpetiformis: case report

Abstract

Impetigo herpetiformis (pustular psoriasis of pregnancy) is a rare dermatosis of pregnancy that typically starts in the 2nd half of pregnancy and resolves postpartum. It may recur in subsequent pregnancies. I present a case of 23 year old female gravida 4 para 3 with recurrent impetigo herpetiformis at 26 weeks gestation. She presented with a one month history of pustular lesions which responded to treatment with prednisone. She delivered at term with a favourable outcome. The disease resolved one month postpartum. This was the second recurrence of the disease. She had her first episode of impetigo herpetiformis during the second pregnancy. The disease recurred in the 3rd pregnancy and resulted in a still birth.

Widespread Erythematous Plaques in a Multigravid Female

“…8 The rash of GPPP is characterized by sterile pustules at the periphery of erythematous plaques initially arising from intertriginous areas of the body with subsequent involvement of the trunk and limbs. 1 Our patient presented in a similar fashion in terms of progression, but interestingly never revealed pustules throughout the course of disease.…”

“…Dermatologic conditions in pregnancy can be attributed to physiological adaptations, changes in pre-existing skin diseases, or development of new dermatologic conditions specific to pregnancy. 1,2 Although controversy exists, there is an ill-defined group of pruritic conditions that are considered pregnancy-specific skin dermatoses, which include pemphigoid gestationis, polymorphic eruption of pregnancy (PEP), intrahepatic cholestasis of pregnancy, atopic eruption of pregnancy, and generalized pustular psoriasis of pregnancy (GPPP). 3 Excluding intrahepatic cholestasis of pregnancy, which presents with secondary skin lesions like excoriations, prurigo nodularis, and occasionally jaundice, these conditions can often manifest as widespread erythematous plaques and papules.…”

Treatment resistant impetigo herpetiformis treated with infliximab

“…There are no standard guidelines for management of the disease but most cases have been successfully treated with systemic corticosteroids at a prednisone dosage of up to 60 mg/day. 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, ).…”

Pustular psoriasis of pregnancy: Clinical and genetic characteristics in a series of eight patients and review of the literature

“…The mean of the gestational age at the onset was 26 ± 5.2 GW in the present cohort similar to the literature. In fact, PPP often occurs in the last trimester of pregnancy 6–9,14–16,20,21,24–27,30,32,35,37 but occurrence in the second trimester is not rare 10–12,15,17–19,23,28,29,31,33,34,36,39 . Early onset at the first trimester of pregnancy is unusual and was reported only in three patients with no history of GPP 5,22 …”