Treatment resistant impetigo herpetiformis treated with infliximab

Abstract

Impetigo herpetiformis is a rare disease of pregnancy with the onset being in the second half of pregnancy and resolution after delivery. It is associated with a high rate of perinatal mortality and fetal abnormalities. Clinical and histological features of the disease are consistent with pustuler psoriasis. We reported a case of 25‐year‐old female gravida 1 para 0, who responded poorly to consecutive treatments with systemic steroids, cyclosporine, intravenous immunoglobulin, and acitretin. Good response was obtained with adding infliximab to the treatment.

Infliximab for the treatment of recalcitrant generalized pustular psoriasis of pregnancy: Report of a challenging case

“…4 However, the available literature data are limited to only four case reports (Table 1). 3,6,11,12 All these patients were recalcitrant to several systemic mono-or combination therapies, but dramatically responded to infliximab, as in our case.…”

“…Topical agents (corticosteroids and calcipotriene for limited disease or as adjunctive therapy), systemic corticosteroids, and cyclosporine are recommended as first-line treatments, whereas phototherapy is a second-line treatment 4. Granulocyte and monocyte adsorption apheresis (GMA) and intravenous immunoglobulin have also been used in the treatment of PPP 3,5,6. Although the pustules of PPP are sterile, systemic antibiotics may also have some benefits 2.…”

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

“…Acitretin, administered for five patients, after childbirth, led to a complete remission in our series. Some authors reported the use of this treatment in post‐partum in PPP, it showed complete remission of the disease in two cases 24,56 except in one who needed the adjunction of biotherapy 7 …”

“…Pustular psoriasis of pregnancy (PPP) conditions Literature (39P) Current study (8 P) Flares number 41 15 Onset disease mean age (years) 27 23 Personal history of psoriasis 13 [5,7,10,11,14,15,17,20,31,34,36,39] 4…”

Successful Treatment of Recurrent Pustular Psoriasis of Pregnancy with Secukinumab: A Case Report

“…Moreover, some studies have suggested that tumour necrosis factor-alpha inhibitor (TNFi) may be effective for severe PPP. Infliximab and adalimumab have been shown to improve health conditions in patients with resistant PPP ( 6 , 7 ). However, these drugs may increase the risk of pustular psoriasis ( 8 ).…”