A 26-yr girl at 31 weeks gestation C/O a 4-week H/O a pustular eruption that developed initially on the periumbilical skin. Subsequently the eruption spread to involve the breasts, back, flexures and proximal limbs. There was cutaneous pain, fever & malaise. O/E the lesions were pustules were arranged in concentric rings while on the breasts there was coalescence of pustules forming lakes of pus. Treatment of choice in this case?
Ans. A Corticosteroidsa. The patient is suffering from Generalized pustular psoriasis of pregnancy.b. A widespread pustular eruption occurring in pregnancy, as characterized by this patient, was originally called 'impetigo herpetiformis', but is now generally regarded as generalized pustular psoriasis (GPP) of pregnancy.c. The eruption usually develops in the third trimester and characteristically initially involves the flexures and periumbilical skin. Small sterile pustules appear on areas of acutely inflamed skin that subsequently expand.d. The pattern of concentric rings of pustules developing around the umbilicus, as seen in our patient, has been observed in other reported cases. Severe constitutional upset is common in GPP of pregnancy, with fever, arthralgia and gastrointestinal symptoms being frequently reported.e. Rx of choice is IV steroids.
Corticosteroids
Methotrexate
Topical itraconazole
Third generation cephalosporins
Miscellaneous