Acute generalised pustular psoriasis of pregnancy
Pustular psoriasis of pregnancy is a rare form of generalized pustular psoriasis, triggered by or occurring in pregnancy. The history and classification will be discussed. It can present at any stage in pregnancy, but usually in the last trimester, with rapid resolution in the postpartum period. Pustules form on a background of erythema, initially at flexural sites and extend centrifugally, either drying in the centre or forming plaques. It can be associated with constitutional symptoms of fever and dehydration and can lead to renal and cardiac failure. Severe and long-standing presentations show higher risk of placental insufficiency and risk of stillbirth, neonatal death or fetal abnormalities. Recurrence in subsequent pregnancies is reported.
An illustrative case report will be discussed of a thirty-one-year-old female, with a history of rheumatoid arthritis, developing a pustular dermatosis at thirty-one weeks gestation. Differential diagnoses will be discussed; including acute generalized exanthematous pustulosis, and the importance of clinico-histopathological correlation.
A multidisciplinary approach is imperative. Dermatologists and Obstetricians must work together and closely monitor when systemic illness occurs, to improve the quality of life of the mother and contribute to a safe delivery of a healthy fetus. Therapeutic management has not yet been standardized, however the treatment of choice in pregnancy is systemic corticosteroids or cyclosporine.
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Dr. Eleni Anthony
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