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Impetigo Herpetiformis


Presentation

  • I present a case of 23 year old female gravida 4 para 3 with recurrent impetigo herpetiformis at 26 weeks gestation. She presented with a one month history of pustular lesions which responded to treatment with prednisone.[ncbi.nlm.nih.gov]
  • The case of a 26-year-old primigravida with IH progressing in the 30th week of her pregnancy is presented. The peculiarity of our presentation relies on the reappearance of the disease postpartum.[ncbi.nlm.nih.gov]
  • Three years later, the patient presented with impetigo herpetiformis again in the second trimester of her second pregnancy.[ncbi.nlm.nih.gov]
  • We present two sisters (twins) with impetigo herpetiformis supporting an inheritance pattern.[ncbi.nlm.nih.gov]
  • To our knowledge, this patient is the second reported case of impetigo herpetiformis presenting during the puerperium. The patient responded quickly to systemic administration of methotrexate and prednisolone.[ncbi.nlm.nih.gov]
Fever
  • Unlike other pregnancy dermatoses, it can be associated with constitutional symptoms including fever, rigors, arthralgia and complications of secondary infection and sepsis. There is an increased risk of fetal anomalies and stillbirths.[ncbi.nlm.nih.gov]
  • This suggests that impetigo herpetiformis should be included in the differential diagnosis of puerperal fever, particularly in those cases associated with dermatoses.[ncbi.nlm.nih.gov]
  • At 35 weeks' gestation, the patient developed a severely pruritic pustular rash with fever and leukocytosis. The skin of the affected areas was biopsied and showed intraepidermal pustules with a neutrophilic infiltrate.[ncbi.nlm.nih.gov]
  • Clinically it is characterized by erythematous plaques surrounded by sterile pustules associated with fever, diarrhea, sweating and increasing risk of stillbirth for placental insufficiency.[ncbi.nlm.nih.gov]
  • It can be associated with constitutional symptom s such as fever, chills, nausea, vomiting and diarrhea.[ncbi.nlm.nih.gov]
Goiter
  • Keywords Psoriasis Goiter Hypoparathyroidism Nodular Goiter Calcium Gluconate Case presentation A 38-year-old Egyptian woman was admitted to Cairo University Hospital with extensive exfoliation of her skin.[casesjournal.biomedcentral.com]
Nail Abnormality
  • There were no nails abnormalities noted. Chvostek and Trousseau signs were negative. There were no personal or family history of similar condition. Figure 1 Erythroderma, multiple crusted plaques and pustules in lower limb.[casesjournal.biomedcentral.com]
Galactorrhea
  • […] distress - Vasa praevia - Uterine rupture - hemorrhage - Placenta accreta - Umbilical cord prolapse - Amniotic fluid embolism Maternal complications in the weeks after childbirth Puerperal fever - Peripartum cardiomyopathy - Postpartum thyroiditis - Galactorrhea[wikidoc.org]
Carpopedal Spasm
  • Carpopedal spasm may be positive before other manifestations of hypocalcemia. [8] If carpopedal spasm appears, treatment with intravenous Ca is indicated until the signs and symptoms of hypocalcaemia subside without waiting for serum calcium levels. [[joacc.com]
Pustular Rash
  • At 35 weeks' gestation, the patient developed a severely pruritic pustular rash with fever and leukocytosis. The skin of the affected areas was biopsied and showed intraepidermal pustules with a neutrophilic infiltrate.[ncbi.nlm.nih.gov]
  • Henson TH, Tuli M, Bushore D, Talanin NY: Recurrent pustular rash in a pregnant woman. Arch Dermatol 2000;136:1055-1060. Baker H, Ryan TJ: Generalized pustular psoriasis. A clinical and epidemiological study of 104 cases.[karger.com]
  • Recurrent pustular rash in a pregnant woman. Arch Dermatol 2000;136: 1055-60. 8. Sauer GC, Geha BJ. Impetigo herpetiformis: report of a case treated with corticosteroid-review of the literature. Arch Dermatol 1961;83: 119-26. 9. Baker H, Ryan TJ.[jsms.sch.ac.kr]
  • In addition to the typical pustular rash with associated systemic symptoms, PPP can present with other cutaneous manifestations and variations.[dovepress.com]
Vaginal Bleeding
  • She had no history of per vaginal bleeding or drainage of liquor. On obstetric evaluation, she had a fundal height corresponding with gestational age. Obstetric ultrasound yielded normal findings. The patient was admitted for inpatient management.[panafrican-med-journal.com]
  • She had no history of The condition was first reported by Ferdinand Ritter von Hebra in per vaginal bleeding or drainage of liquor. On obstetric evaluation, 1872.[docksci.com]
Neglect
  • Even though the case is not new per se, it reveals the natural course of this rare disease because the condition was neglected and given no oral treatment throughout the entire pregnancy.[ncbi.nlm.nih.gov]
Lethargy
  • Characteristics include pruritic sterile pustules that resolve with desquamation; patients have hypocalcemia and hypoalbuminemia with fever, lethargy, and potentially fatal tetany . Medical dictionary . 2011 .[medicine.academic.ru]

Treatment

  • After six weeks of oral prednisolone treatment, the lesions improved, but there were still new pustule formations and narrowband ultraviolet B treatment was added.[ncbi.nlm.nih.gov]
  • Within several days of delivery, the eruptions began to resolve, and no recurrence was observed after treatment with oral prednisolone was stopped 31 days after delivery.[ncbi.nlm.nih.gov]
  • Initial treatment with topical and systemic corticosteroids failed and oral methotrexate was added. She responded well to this therapy and required only 2 doses of weekly methotrexate.[ncbi.nlm.nih.gov]
  • After unsuccessful attempts of treatment with systemic corticosteroids, intravenous fluids, and antibiotics, treatment was switched to cyclosporine, but no therapeutic effect could be achieved.[ncbi.nlm.nih.gov]
  • Impetigo herpetiformis is a rare, potentially serious skin disorder occurring particularly during pregnancy, and must be diagnosed early to allow prompt, aggressive treatment.[ncbi.nlm.nih.gov]

Prognosis

  • Although IH is associated with high mortality and morbidity in both fetus and mother, a better prognosis could be achieved with an immediate diagnosis and proper treatment.[ncbi.nlm.nih.gov]
  • It was previously associated with high maternal and fetal mortality and morbidity, but now has a better prognosis.[ncbi.nlm.nih.gov]
  • This similarity has led authors to name the disease "pustular psoriasis of pregnancy". 2 The maternal-fetal prognosis is uneven.[ncbi.nlm.nih.gov]
  • Early diagnosis and proper treatment is important in order to get a better prognosis for both the mother and baby.[e-sciencecentral.org]
  • The urgency of the problems associated with a poor prognosis for pregnant women. Dermatology is usually considered endocrine, metabolic, infectious impetigo Gebre pathogenesis.[medicalformat.com]

Etiology

  • Impetigo herpetiformis (IH) is a rare pustular dermatosis that typically occurs in pregnant women with unknown etiology.[ncbi.nlm.nih.gov]
  • The etiology of the disease is unclear and it is not known if genetic factors play a role. We present two sisters (twins) with impetigo herpetiformis supporting an inheritance pattern.[ncbi.nlm.nih.gov]
  • Impetigo Herpetiformis is a rare pustular dermatosis that typically occurs in pregnant women with unknown etiology. A 17 year old patient who developed Impetigo Herpetiformis for the second time in the 27th week of her 2nd pregnancy is presented.[ncbi.nlm.nih.gov]
  • Abstract Impetigo Herpetiformis is a rare pustular dermatosis that typically occurs in pregnant women with unknown etiology.[unboundmedicine.com]
  • […] and crust evolution, all of which evolved into fetal deaths, in addition to four maternal deaths. 3 Currently, some authors use the term "pustular psoriasis of pregnancy"(PPG), based on the fact that the pustules are sterile and do not present viral etiology[ncbi.nlm.nih.gov]

Epidemiology

  • Baker H, Ryan TJ: Generalized pustular psoriasis: a clinical and epidemiological study of 104 cases. Brit J Dermatol 1968;80:77.[karger.com]
  • A clinical and epidemiological study of 104 cases. Br J Dermatol 80:771–793 PubMed CrossRef Google Scholar 4. Beveridge G W, Harkness RA, Livingstone JR (1966) Impetigo herpetiformis in two successive pregnancies.[link.springer.com]
Sex distribution
Age distribution

Pathophysiology

  • A better understanding of the pathophysiology of AIKD is likely to lead to innovative, targeted therapies that benefit patients.[kclpure.kcl.ac.uk]

Prevention

  • Impetigo herpetiformis is a rare dermatosis of pregnancy that requires early recognition and treatment to prevent maternal and fetal morbidity. Combination therapy using oral corticosteroids and short-term methotrexate is effective.[ncbi.nlm.nih.gov]
  • An experienced medical team comprising obstetricians, dermatologists, perinatologists and neonatologists is critical to aggressively treat this life-threatening specific dermatosis of pregnancy and to prevent ensuing complications, such as fluid and electrolyte[ncbi.nlm.nih.gov]
  • Your skin Holds body fluids in, preventing dehydration Keeps harmful microbes out, preventing infections Helps you feel things like heat, cold, and pain Keeps your body temperature even Makes vitamin D when the sun shines on it Anything that irritates[icdlist.com]
  • Good handwashing prevents spread. ...Read more[healthtap.com]

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