Impetigo herpetiformis is a form of severe pustular
psoriasis occurring in
pregnancy[1][2] which may occur during any trimester.[3][4]
Signs and symptoms
The typical lesions are centrifugally extending
erythematous patches with marginally grouped sterile
pustules; they can also develop erosion, crust, and
impetiginization. These lesions are mainly seen in flexural regions. Patients may experience vegetative lesions resembling
Pemphigus vegetans, though they are uncommon.[5] It is possible to see mucosal lesions in the tongue, mouth, and even
esophagus in addition to nail involvement.[6]
The cause of impetigo herpetiformis is not yet clear.[8] Some evidence suggests that genetic factors may play a role in the development of impetigo herpetiformis, such as the number of familial cases.[9]
Diagnosis
The diagnosis of impetigo herpetiformis is supported by clinical and laboratory findings, and
histological examination primarily reveals
neutrophilc inflammatory infiltrate, epidermal
acanthosis, and
papillomatosis with focal
parakeratosis.[10] Spongiform pustules of Kogoj are intraepidermal multilocular microabscesses that are formed by
neutrophil collections.[11]
Pustular psoriasis is still primarily treated with systemic
corticosteroids, which have been used for many years.[13] If a patient is not responding to
corticosteroids,
cyclosporine may be a useful medication.[14] In impetigo herpetiformis, the use of
antibiotics appears to be beneficial, despite the fact that they cannot completely eradicate the illness.[15][16]
^Sárdy, M; Preisz, K; Berecz, M; Horváth, C; Kárpáti, S; Horváth, A (May 5, 2006). "Methotrexate treatment of recurrent impetigo herpetiformis with hypoparathyroidism". Journal of the European Academy of Dermatology and Venereology. 20 (6). Wiley: 742–743.
doi:
10.1111/j.1468-3083.2006.01473.x.
ISSN0926-9959.
PMID16836512.
S2CID46004532.
^Breier-Maly, J.; Ortel, B.; Breier, F.; Schmidt, J.B.; Hönigsmann, H. (1999). "Generalized Pustular Psoriasis of Pregnancy (Impetigo herpetiformis)". Dermatology. 198 (1). S. Karger AG: 61–64.
doi:
10.1159/000018066.
ISSN1018-8665.
PMID10026404.
S2CID21334983.
^Gao, Qian-Qian; Xi, Ming-Rong; Yao, Qiang (2013). "Impetigo Herpetiformis during Pregnancy: A Case Report and Literature Review". Dermatology. 226 (1). S. Karger AG: 35–40.
doi:
10.1159/000346578.
ISSN1018-8665.
PMID23446290.
S2CID42999570.
^Luan, Li; Han, Shixin; Zhang, Zhenying; Liu, Xiaoming (December 10, 2013). "Personal treatment experience for severe generalized pustular psoriasis of pregnancy: two case reports". Dermatologic Therapy. 27 (3). Hindawi Limited: 174–177.
doi:
10.1111/dth.12112.
ISSN1396-0296.
PMID24517287.
S2CID37248288.
^Tintinger, G. R.; Anderson, R.; Feldman, C. (March 15, 2013). "Pharmacological approaches to regulate neutrophil activity". Seminars in Immunopathology. 35 (4). Springer Science and Business Media LLC: 395–409.
doi:
10.1007/s00281-013-0366-8.
ISSN1863-2297.
PMID23494251.
S2CID253808218.