Dermatological Emergency In Pregnancy – A Case Of Generalised Pustular Psoriasis In An Obstetric Setting

Dermatological Emergency In Pregnancy – A Case Of Generalised Pustular Psoriasis In An Obstetric Setting

Arthi Subramanian , Adedayo Taiwo, Anabela Serranito
Our Lady of Lourdes Hospital, Drogheda, Ireland

Introduction: Pustular psoriasis of pregnancy (PPP) is a rare form of generalised pustular psoriasis occurring exclusively during pregnancy, typically emerging in the third trimester. With fewer than 400 documented cases since 2000, awareness is vital, as untreated PPP can lead to serious complications for both mother and fetus.

Case Description: A 37-year-old Eastern European woman, with a psoriasis history since age 15, experienced an acute flare-up at 37 weeks and 3 days of gestation. She presented with severe itching and widespread pustular rashes. A skin biopsy confirmed PPP. Treatment included emollients, corticosteroids, intravenous fluids, and prophylactic low-molecular-weight heparin. Induction of labour was planned for 39 weeks, but an emergency caesarean section was performed at 38+3 weeks due to fetal compromise, resulting in good outcomes for both mother and baby.

Discussion: Metabolic changes during pregnancy can trigger PPP, characterised by severe, sterile pustules. Corticosteroid treatment is often effective. PPP can lead to systemic symptoms in the mother, including fever and electrolyte imbalances, potentially resulting in severe complications like sepsis. It also risks disrupting placental blood flow, which can lead to intrauterine growth restriction or fetal demise.

Main Learning Points: PPP is a serious and rare condition during pregnancy requiring early diagnosis and treatment due to its risks for both mother and fetus.

Keywords: Generalised pustular psoriasis, Pustular psoriasis in pregnancy, Impetigo herpatiformis