OB

Impetigo Herpetiformis

search

Impetigo Herpetiformis, Pustular Psoriasis of Pregnancy, Generalized Pustular Psoriasis of Pregnancy

  • See Also
  1. Skin Conditions of Pregnancy
  • Epidemiology
  1. Rare pregnancy-related disorder
  • Pathophysiology
  1. Generalized Pustular Psoriasis variant specific to pregnancy
  • Symptoms
  1. Rash develops in third trimester
  2. No Pruritus
    1. Contrast with nearly every other specific cause of Skin Conditions of Pregnancy
    2. See Pruritus in Pregnancy
  3. Systemic symptoms may develop (related to complications)
    1. Nausea or Vomiting
    2. Diarrhea
    3. Fever and chills
  • Signs
  • Skin
  1. Pustular Psoriasis
    1. Starts as Pustules
    2. Pustular lesions coalesce into Plaques
    3. Plaques desquamate
  2. Lesion Distribution
    1. Starts in the intertriginous areas (e.g. inguinal and axillary folds)
    2. Spreads centrifugally to the extremities
    3. Spares the face, palms and soles
  3. Associated Findings
    1. Lymphadenopathy
  • Management
  1. Increased antepartum observation (fetal surveillance)
  2. High dose Systemic Corticosteroids
    1. Prednisone 20-60 mg daily with taper
  3. Severe cases
    1. Cyclosporine
    2. Infliximab (TNF Inhibitor)
    3. UVB Phototherapy
  4. Antibiotics
    1. As indicated for secondary Skin Infections
  • Complications
  • Maternal
  1. Secondary Bacterial Infection (may be systemic)
  2. Hyperparathyroidism
  3. Hypocalcemia
  4. Hypoalbuminemia
  • Complications
  • Fetus
  1. Adverse fetal outcomes
  2. Placental insufficiency
  3. Fetal demise
  • Course
  1. Onset in third trimester of pregnancy
  2. Resolves after delivery
  3. May recur with future pregnancies
  • References
  1. Erlandson (2023) Am Fam Physician 107(2): 152-8 [PubMed]
  2. Namazi (2018) Dermatol Res Pract 2018:5801280 +PMID: 29849579 [PubMed]
  3. Trivedi (2018) Int J Womens Health 10:109-15 +PMID: 29520163 [PubMed]