Generalized pustular psoriasis of pregnancy successfully treated with cyclosporine Debeeka Hazarika Department of Dematology, Assam Medical College and Hospital, Dibrugarh, Assam, India Date of Web Publication12-Nov-2009. Abstract Two multigravidae aged 27 and 29 years, with previous uneventful pregnancies, second being psoriatic, reported at 24 and 28 weeks of pregnancies, with generalized pustular lesions. Patients were put on cyclosporine 3 mg/ kg weight/ day after failure of an initial systemic steroid. We report here two cases of pustular psoriasis in pregnancy, which were successfully treated with cyclosporine. Generalized pustular psoriasis of pregnancy treated with oral cyclosporin MM Kura, AU Surjushe Department of Skin and STD, Grant Medical College and JJ Hospital, Mumbai, India. 4 Systemic steroids are the drugs of choice for the treatment. Though there are reports of its use in this condition in a few cases, the experience is limited. 5 Our patient was a case of precious pregnancy not showing adequate response to oral steroids that was treated effectively with cyclosporin. The goals of treatment of generalized pustular psoriasis (GPP) are to improve skin manifestations, to alleviate associated s. The acute variant (also known as generalized pustular psoriasis of von Zumbusch) is characterized by sudden onset of the pustular eruption accompanied by systemic symptoms of fever and malaise. Treatment of recalcitrant pustular psoriasis with infliximab: effective reduction of chemokine expression.
Impetigo herpetiformis (IH) is a rare pustular form of psoriasis in pregnancy, associated with constitutional symptoms and complications of secondary infection and sepsis and an increased risk of fetal abnormalities and stillbirths. Here we present a series of four cases of impetigo herpetiformis, primarily treated with systemic corticosteroids. Case 2:- A 27 years old primigravida, presented with fever and generalized pustular lesions at 26 weeks of gestation for two weeks. The onset in our patients was between 24 to 26 weeks of gestation as reported earlier 6,7. Pustular psoriasis is an uncommon form of psoriasis consisting of widespread pustules on an erythematous background, as shown in the image below. The acute generalized type is also termed von Zumbusch variant. It tends to run a subacute or chronic course with fewer systemic manifestations. Acrodermatitis continua of Hallopeau: Characterized by pustular eruptions of the tips of fingers and toes, cases are generally refractory to treatment. Any systemic upset, such as fever and malaise, which are common in unstable forms of psoriasis such as erythroderma or generalised pustular psoriasis. A Scottish study reported that home treatment was safe and effective and its provision should be encouraged. Pustular flares of disease may be provoked by systemic corticosteroid therapy.
Keywords: Arthritis, psoriatic; Lactation; Pregnancy; Psoriasis. Some cases of salicylism have been reported with the use of topical salicylic acid in concentrations ranging from 1 to 40. Systemic corticosteroids are not routinely used in the treatment of psoriasis, because even though they result in the rapid clearing of lesions, reactivation of symptoms is common, demandingprogressively higher doses of medication with consequent increase in the incidence of adverseevents. 17 In addition, their use may precipitate the development of erythrodermic or generalized pustular psoriasis. Some cases of acute guttate flares following streptococcal infection are precipitated by its superantigen exotoxin. Pregnancy and rapid tapering of systemic corticosteroids are known triggers. Generalized pustular psoriasis in pregnancy is also known as impetigo herpetiformis. Systemic therapy is effective, in treating severe disease (affecting more than 5 body surface area) and disease significantly involving the hands, feet or genitalia, however they have greater potential for toxicity. Clinicians may be confronted with difficult-to-treat psoriasis cases for which there are scant data to rely upon for guidance. There are other also case reports supporting the efficacy of cyclosporine as a monotherapy and in combination with acitretin (grade D evidence) 39 41. Systemic corticosteroids were also found to be efficacious when used only in the presence of severe systemic symptoms.
Impetigo Herpetiformis: A Challenging Scenario To The Treating Dermatologist: A Case Series, Edoj10(2):
Generalized pustular psoriasis also can cover most of the body. More than one study indicates a combination of acitretin (brand name Soriatane) and methotrexate can send pustular psoriasis into rapid remission and eventual clear the skin; however these medications do not need to be combined to be effective for pustular psoriasis. Von Zumbusch: Treatment often consists of acitretin, cyclosporine or methotrexate. Treatment options for moderate to severe psoriasis include topical and systemic medications, phototherapy, and excimer laser, Combination therapies are often more effective than one treatment alone. In some cases, the psoriasis may cover the scalp with thick plaques that extend down from the hairline to the forehead. A number of conditions may trigger pustular psoriasis, including infection, pregnancy, certain drugs, and metal allergies. The more powerful the corticosteroid, the more effective it is. This frequently results from withdrawal of systemic corticosteroid therapy. Generalized acute pustular psoriasis (von Zumbusch) This female patient was toxic and had fever and peripheral leukocytosis. Impetigo herpetiformis, or pustular psoriasis of pregnancy, is a very rare skin disorder with few cases described in the medical literature. Stopping systemic corticosteroids in a patient known to have psoriasis notoriously elicits a flare. Von Zumbusch Generalized Pustular Psoriasis (GPP) can be life-threatening but is rare. The acute onset, often within hours, is accompanied by fever, headache and malaise, and it can persist for weeks if not treated. Impetigo herpetiformis is a variant of pustular psoriasis that occurs during pregnancy. Psoriasis is a long-lasting autoimmune disease characterized by patches of abnormal skin. About 75 of cases can be managed with creams alone. The development of generalized pustular psoriasis is often caused by an infection, abrupt withdrawal of topical corticosteroid treatment, pregnancy, hypocalcemia, medications, or following an irritating topical treatment for plaque psoriasis. Generalized pustular psoriasis of pregnancy (GPPP) is a rare and severe variant of pustular psoriasis. We compared our two GPPP cases and found that cyclosporine and a sufficient dosage of steroid were an effective treatment. Fifty-four patients responded to systemic retinoid, 21 to methotrexate, eight to cyclosporine, and one to adalimumab, but recurrences were common.
Treatment Of Psoriasis And Psoriatic Arthritis During Pregnancy And Breastfeeding
Topical treatment of mild to moderate non-scalp plaque psoriasis vulgaris in adults. Adverse reactions found in connection with systemic corticosteroid treatment, such as adrenocortical suppression or impact on the metabolic control of diabetes mellitus, may occur also during topical corticosteroid treatment due to systemic absorption. When treating psoriasis with topical corticosteroids, there may be a risk of generalised pustular psoriasis or of rebound effects when discontinuing treatment. There are no adequate data from the use of Dovobet in pregnant women. Generalized pustular psoriasis (GPP) includes acute type due to pregnancy known as impetigo herpetiformis (IH), infantile and juvenile, and circinate and localized (not hands and feet). This case is rare as treatment of lactating female with resistant pustular psoriasis with NB-UVB therapy and azathioprine has not been reported as yet. Generalized pustular psoriasis of pregnancy treated with narrowband UVB and topical steroids.