Two case reports of generalized pustular psoriasis of pregnancy: Different outcomes

Abstract

Generalized pustular psoriasis of pregnancy is a rare dermatosis with potential serious consequences for both the mother and fetus. Treatment is difficult and historically steroids were the mainstay of treatment. Cyclosporin has been used for a few cases resistant to steroids. We report our own experience of two cases of generalized pustular psoriasis of pregnancy. Cases of generalized pustular psoriasis of pregnancy need review by a dermatologist with experience of skin disorders in pregnancy. Both the fetus and mother need to be monitored closely when systemic illness occurs, as there is a risk of stillbirth. Maternal sepsis is a known complication of generalized pustular psoriasis of pregnancy. Cyclosporin, when used appropriately is effective and relatively safe.

Recurrent impetigo herpetiformis: case report

“…Although our patient was treated successfully with prednisone, some unresponsive cases to prednisone have been reported [ 13 - 15 ]. Successful treatment with cyclosporine has been reported and this regime can be used as second line treatment [ 6 , 16 , 17 ]. Antibiotics may be used to prevent and treat infections.…”

Widespread Erythematous Plaques in a Multigravid Female

“…10 Differing opinions exist as to whether personal or family history of psoriasis confers increased risk of GPPP. 7,10,11,12 Our patient had no personal or family history and reported complete resolution eight weeks postpartum with only faint post-inflammatory erythema.…”

“…Numerous publications note rapid resolution of disease following delivery, but some reports suggest GPPP may recur in subsequent pregnancies. 10,11,12 In some instances it has been reported that the pustular form evolved into classic psoriatic lesions. 10 Differing opinions exist as to whether personal or family history of psoriasis confers increased risk of GPPP.…”

Pustular psoriasis of pregnancy: current perspectives

“…Unlike many other dermatoses of pregnancy, which are usually limited to the skin, PPP is frequently accompanied by systemic signs and symptoms of fatigue, fever, diarrhea, delirium, elevated markers of inflammation such as an increased erythrocyte sedimentation rate, and increased white blood cell counts. 5 , 17 In severe cases, the rash of PPP can progress to erythroderma with resulting dangerous fluid and electrolyte imbalances, loss of thermoregulation in the skin, and the risk of secondary infection and sepsis. 18 …”

“…In a large number of women with PPP, there is a positive personal or family history of psoriasis; nevertheless, there are still many cases without a known family history of psoriasis. 17 Hypoparathyroidism, hypocalcemia, stress, and infections have been suggested as potential triggers of PPP, although causal associations have not been elucidated. 16 , 18 In addition, if a woman develops PPP during one pregnancy, there is an increased risk of more severe outbreaks in subsequent pregnancies that may present earlier.…”