Presentation
We are presenting a case of impetigo herpetiformis scheduled for an emergency caesarean section. Written consent to publish details of the case was obtained prior to the procedure. [joacc.com]
We report a case of a patient presenting with two consecutive pregnancies complicated by impetigo herpetiformis. The disease appeared much earlier than the classic third trimester presentation. [annsaudimed.net]
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]
Entire Body System
- 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]
- Chills
It can be associated with constitutional symptom s such as fever, chills, nausea, vomiting and diarrhea. [ncbi.nlm.nih.gov]
Patients may become extremely ill with fever, chills, nausea, vomiting, diarrhoea, and tetany. Hypocalcaemia has often been reported. [dermis.net]
Acute onset with severe impairment of the general condition, with pronounced feeling of illness, fever, chills, possibly diarrhoea. On the integument bent exanthema with highly red, large erythema and plaques. [altmeyers.org]
The rash may be accompanied by systemic symptoms including fever, chills, nausea, vomiting, lymphadenopathy, seizure, and malaise. [visualdx.com]
- Fatigue
A 25-year-old woman, in her 9th month of pregnancy, was admitted because of general fatigue, a low grade fever, annular or circinate erythema with groups of small pustules. [jstage.jst.go.jp]
Symptoms impetigo herpetiformis Impetigo herpetiformis is often accompanied by symptoms such as fever, vomiting, diarrhea, chills, nausea, and fatigue. Some women have low levels of calcium and phosphate in the blood. [impetigo-treatment.learnandenjoy.com]
Symptoms Impetigo herpetiformis is frequently accompanied by significant symptoms such as fever, chills, nausea, vomiting, diarrhea, and fatigue. Some women experience low levels of calcium and phosphate in the blood. [verywell.com]
Weakness and random fatigue (even after a full night of sleep).skin. [edenbio.eu]
- Falling
Women with a parathyroid disorder called hypoparathyroidism may be susceptible to this condition during pregnancy as calcium and albumin levels in the blood fall. [impetigo-treatment.learnandenjoy.com]
It is likely that further inflammatory keratinization disorders will also fall within the concept of AIKD, as elucidation of novel pathogenic mechanisms of inflammatory keratinization diseases emerge. [kclpure.kcl.ac.uk]
Role of calcium has been described in this disease process and treatment of hypocalcaemia may regress this disorder.[6] Respiratory alkalosis secondary to hyperventilation is the most common cause of acute fall of serum ionised calcium (Ca ++). [joacc.com]
Who Is at Risk Women who have a parathyroid disorder called hypoparathyroidism may be susceptible to this condition during pregnancy as calcium and albumin levels in the blood fall. [verywell.com]
- Rigor
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]
It was not associated with chills or rigors. The rise in temperature was also associated with a flare-up of the lesions. She did not give any personal or family history of psoriasis. Her earlier two pregnancies were uneventful. [ijdvl.com]
Gastrointestinal
- Diarrhea
It can be associated with constitutional symptom s such as fever, chills, nausea, vomiting and diarrhea. [ncbi.nlm.nih.gov]
Symptoms impetigo herpetiformis Impetigo herpetiformis is often accompanied by symptoms such as fever, vomiting, diarrhea, chills, nausea, and fatigue. Some women have low levels of calcium and phosphate in the blood. [impetigo-treatment.learnandenjoy.com]
The skin eruption is accompanied by fever, malaise, delirium, nausea, diarrhea and vomiting, neutrophilia, elevated erythrocyte sedimentation rate, hypocalcemia and tetany. Severe dehydration, prostration and convulsions have been reported. [annsaudimed.net]
Grave systemic manifestations were present’ together with eosinophilia, albuminuria, hematuria, diarrhea, amenorrhea, mucous membrane, and nail bed involvement. The serum calcium was low before delivery but tetany was never demonstrated. [ajog.org]
- Hematochezia
Haug Browse recently published Learning/CME Learning/CME View all learning/CME CME Partial Oral versus Intravenous Antibiotic Treatment of Endocarditis Case 4-2019: An 18-Year-Old Man with Abdominal Pain and Hematochezia Bridging the Gap Challenge Yourself [nejm.org]
Cardiovascular
- Hypertension
The patient was a 25-year-old primigravida with pregnancy-induced hypertension (PIH). At 35 weeks' gestation, the patient developed a severely pruritic pustular rash with fever and leukocytosis. [ncbi.nlm.nih.gov]
hypertension - Pre-eclampsia - Eclampsia - Gestational diabetes Other, predominantly related to pregnancy Hyperemesis gravidarum - Gestational pemphigoid - Intrahepatic cholestasis of pregnancy Maternal care related to the fetus and amniotic cavity and [wikidoc.org]
[…] disorders Gestational hypertension Pre-eclampsia HELLP syndrome Eclampsia Other, predominantly related to pregnancy Digestive system Acute fatty liver of pregnancy Gestational diabetes Hepatitis E Hyperemesis gravidarum Intrahepatic cholestasis of pregnancy [en.wikipedia.org]
Apply new evidence-based management options to treat genetic and constitutional factors leading to a high-risk pregnancy (such as diabetes, obesity, hypertension, and cardiac disease) through new and expanded coverage of these increasingly common presentations [books.google.com]
Skin
- Eruptions
Although ritodrine-induced pathognomonic cutaneous eruptions are rare, we would like to emphasize that ritodrine can cause drug-induced pustular eruptions distinctly resembling life-threatening impetigo herpetiformis. [ncbi.nlm.nih.gov]
At 36 weeks, she presented with a one-week history of malaise, fever, leg pains and worsening of the previously noted generalized skin eruption. [annsaudimed.net]
Her skin eruption improved dramatically after 5 GCAP treatments. However, 3 weeks after another cessation of GCAP treatment, her skin eruption again exacerbated. [medicaljournals.se]
- Dermatitis
Pustules develop on this area, soon forming crusty, yellow brown sores that can spread to cover … Medical dictionary Dermatitis herpetiformis — Classification and external resources Dermatitis herpetiformis characteristic rash ICD 10 L … Wikipedia Импети́го [medicine.academic.ru]
Dermat. 1908; 93: 43 Scopus (1) Crossref Google Scholar Klopstock E Dermat. Ztschr. 1924; 40: 305 Crossref Google Scholar Werther J Dermat. Wchnschr. 1925; 37: 1334 Google Scholar Leszczynski Arch. f. Dermat. u. [ajog.org]
HERPETIFORMIS, DUHRING DIS, DUHRINGS DIS, dermatitis herpetiformis, dermatitis herpetiformis (diagnosis), Dermatitis Herpetiformis [Disease/Finding], disease duhring's, duhrings disease, herpetiformis dermatitis, Dermatitis;herpetiformis, duhring disease [fpnotebook.com]
Pityriasis rosea Pityriasis rubra pilaris Pyogenic granuloma Sebaceous cyst Seborrheic dermatitis Seborrheic keratosis Skin and hair changes during pregnancy Skin flaps and grafts -- self-care Skin graft Skin lesion biopsy Skin self-exam Stasis dermatitis [icdlist.com]
- Papule
(widespread pruritic eczematous papules and plaques favoring the flexural surfaces). [visualdx.com]
Impetigo Herpetiformis Striae Gravidarum Pigmentation Papules and Plaques of Pregnancy Papules et plaques urticariennes prurigineuses de grossesse, Eruption polymorphe de grossesse No results found for this meaning. Results: 3. Exact: 3. [context.reverso.net]
Clinically, it presents as excoriated papules or nodules, eczematous papules and plaques, or monomorphic follicular-based papules on the abdomen, flexural areas, and extremities. [contemporaryobgyn.net]
Pruritic urticarial papules and plaques of pregnancy. The rash presentation can vary; two examples are shown above. Figure 3. Pruritic urticarial papules and plaques of pregnancy. The rash presentation can vary; two examples are shown above. [aafp.org]
- 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]
- Skin Rash
Several skin rashes that occur during pregnancy are abnormal and potentially harmful to the fetus. Whenever an unusual rash occurs in pregnancy, medical attention should be sought as soon as possible. [livestrong.com]
Pustular psoriasis of pregnancy should be considered in a pregnant woman with a spreading pustular skin rash and constitutional symptoms. [dermnetnz.org]
rash Hives look like raised bumps or welts on the skin. [medicalnewstoday.com]
Neurologic
- 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]
Workup
Laboratory workup revealed leukocytosis of 21.5×109/L (reference range, 4.5–11.0×109/L) with neutrophilic predominance of 73.6% (reference range, 56%), an elevated erythrocyte sedimentation rate (ESR) of 40 mm/h (reference range, 0–20 mm/h), and a mild [mdedge.com]
[…] materials: o Classification, o Suture size, o Type and size of needle ♦ Types of suturing: o simple interrupted, o mattress, vertical & horizontal o Intradermal buried, o S.C. buried, o Running subcuticular, o Figure of 8 ♦ Suture removal ♦ Preoperative workup [medicaldialogues.in]
Serum
- Hypercholesterolemia
[…] lymphangioma circumscriptum (številka: 4, 2009) Assessment of general health and quality of life in patients with acne using avalidated generic questionnaire (številka: 4, 2009) Cutaneous horn (številka: 4, 2009) Skin manifestations in familial heterozygous hypercholesterolemia [dlib.si]
Treatment
Immediately after discontinuing the treatment, the patient became pregnant again. She had a recurrence of the extensive pustular lesions at 16 weeks, and treatment with prednisolone had to be started again. [annsaudimed.net]
There-fore, a total of 14 GCAP treatments were performed during her 4 th gestation. After the treatment, her skin eruption improved dramatically (Psoriasis Area and Severity Index (PASI) score before and after treatment, 24.2 and 0, respectively). [medicaljournals.se]
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]
Although many treatment options have been proposed for IH, there is no specific guideline and the evidence for efficacy of treatments is poor. [hindawi.com]
Prognosis
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. [scielo.br]
(Outcomes/Resolutions) In general, the prognosis for Impetigo is excellent with suitable treatment. [dovemed.com]
Etiology
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]
Abstract Impetigo Herpetiformis is a rare pustular dermatosis that typically occurs in pregnant women with unknown etiology. [unboundmedicine.com]
It is also otherwise termed as “pustular psoriasis of pregnancy”, owing to the fact that the pustules are sterile and are not associated with a viral etiology. [pesquisa.bvsalud.org]
Epidemiology
Hospital of Oujda, Medical School of Oujda, Mohammed First University of Oujda, Morocco Siham Dikhaye Department of Dermatology, Mohammed VI University Hospital of Oujda, Medical School of Oujda, Mohammed First University of Oujda, Morocco Department of Epidemiology [sci-rep.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]
[…] plaques bordered by pustules; (C) confluent erythema with desquamation Journal Journal ID (nlm-ta): Pan Afr Med J Journal ID (iso-abbrev): Pan Afr Med J Journal ID (publisher-id): PAMJ Title: The Pan African Medical Journal Publisher: The African Field Epidemiology [scienceopen.com]
Pathophysiology
A better understanding of the pathophysiology of AIKD is likely to lead to innovative, targeted therapies that benefit patients. [kclpure.kcl.ac.uk]
Pathophysiology and treatment of psoriasis. Am. J. Health Syst. [ejog.org]
[…] compound heterozygous mutations in IL36RN after remission with secukinumab. 62 Kanatani Y...Asada H 34806229 2022 9 An arcane presentation of pustular psoriasis in pregnancy: case report. 62 Raja A...Baalann KP 36699980 2022 10 Pustular Psoriasis: From Pathophysiology [malacards.org]
On the other hand, the contribution of innate immunity in the disease pathophysiology of SJS/TEN has been largely unexplored. [mdpi.com]
Ischaemic ulcer DISORDER OF LYMPHATIC VESSELS Must know Should know Good to know ♦ Lymphangiogenesis ♦ Functional Anatomy of skin lymphatics ♦ Identification of skin lymphatics ♦ Lymph transport ♦ Immune function ♦ Oedema/Lymphoedema o Epidemiology o Pathophysiology [medicaldialogues.in]
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]
Efforts should be directed toward maintaining the general condition of the patient and toward the prevention and control of secondary infection. In pregnancy the disease is an indication for termination and the prevention of future pregnancies. [ajog.org]
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]