Impetigo herpetiformis explained

Impetigo herpetiformis
Synonyms:Pustular psoriasis of pregnancy

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]

In impetigo herpetiformis, hypoparathyroidism and hypocalcemia may be encountered.[7] Systematic symptoms such as malaise, hypovolemic shock, vomiting, chills, fever, diarrhea, and seizures may also be seen.[8]

Causes

The cause of impetigo herpetiformis is not yet clear. 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]

Laboratory findings include iron deficiency anemia, hypoalbuminemia, hypocalcemia, elevated erythrocyte sedimentation rate, and leukocytosis.[12]

Treatment

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]

See also

Further reading

External links

Notes and References

  1. James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. Page 471. .
  2. Tunzi M, Gray GR . Common skin conditions during pregnancy . Am Fam Physician . 75 . 2 . 211–8 . January 2007 . 17263216 .
  3. Web site: DermIS — Impetigo Herpetiformis (Information on the diagnosis) . 2009-11-29 . https://web.archive.org/web/20180808012547/http://dermis.net/dermisroot/en/29476/diagnose.htm . 2018-08-08 . dead .
  4. Book: Rapini, Ronald P. . Bolognia, Jean L. . Jorizzo, Joseph L. . Dermatology: 2-Volume Set . Mosby . St. Louis . 2007 . 978-1-4160-2999-1 .
  5. Namazi . Nastaran . Dadkhahfar . Sahar . Impetigo Herpetiformis: Review of Pathogenesis, Complication, and Treatment . Dermatology Research and Practice . Hindawi Limited . 2018 . 2018 . 1687-6105 . 10.1155/2018/5801280 . free . 1–4. 29849579 . 5904797 .
  6. Fouda . Usama M . Fouda . Ragai M . Ammar . Hussam M . Salem . Mohamed . Darouti . Mohamed EL . Impetigo herpetiformis during the puerperium triggered by secondary hypoparathyroidism: a case report . Cases Journal . Springer Science and Business Media LLC . 2 . 1 . 2009 . 1757-1626 . 10.1186/1757-1626-2-9338 . free . 9338. 20072676 . 2806392 .
  7. Sárdy . M . Preisz . K . Berecz . M . Horváth . C . Kárpáti . S . Horváth . A . Methotrexate treatment of recurrent impetigo herpetiformis with hypoparathyroidism . Journal of the European Academy of Dermatology and Venereology . Wiley . 20 . 6 . May 5, 2006 . 0926-9959 . 10.1111/j.1468-3083.2006.01473.x . 742–743. 16836512 . 46004532 .
  8. Henson . T. H. . Recurrent Pustular Rash in a Pregnant Woman . Archives of Dermatology . American Medical Association (AMA) . 136 . 8 . August 1, 2000 . 0003-987X . 10.1001/archderm.136.8.1055-a . 1055–a–1060. 10926744 .
  9. Erbagci . Z . Erkiliç . S . A Case of Recurrent Impetigo Herpetiformis with a Positive Family History . International Journal of Clinical Practice . 54 . 9 . 2000 . 1368-5031 . 10.1111/j.1742-1241.2000.tb10938.x . 619–620. 11220992 . 42807497 .
  10. Kondo . Rogerio Nabor . Araújo . Fernanda Mendes . Pereira . Allamanda Moura . Lopes . Vivian Cristina Holanda . Martins . Ligia Márcia Mario . Pustular psoriasis of pregnancy (Impetigo herpetiformis) - case report . Anais Brasileiros de Dermatologia . FapUNIFESP (SciELO) . 88 . 6 suppl 1 . 2013 . 0365-0596 . 10.1590/abd1806-4841.20132134 . 186–189. 24346915 . 3875976 .
  11. Azulay-Abulafia . Luna . Brotas . Arles . Braga . Antônio . Volta . Andréia Cunha . Gripp . Alexandre Carlos . Psoríase pustulosa da gestação (impetigo herpetiforme): relato de dois casos e revisão da literatura . Revista Brasileira de Ginecologia e Obstetrícia . FapUNIFESP (SciELO) . 26 . 2 . 2004 . 0100-7203 . 10.1590/s0100-72032004000200011 . 153–159. free .
  12. Breier-Maly . J. . Ortel . B. . Breier . F. . Schmidt . J.B. . Hönigsmann . H. . Generalized Pustular Psoriasis of Pregnancy (Impetigo herpetiformis) . Dermatology . S. Karger AG . 198 . 1 . 1999 . 1018-8665 . 10.1159/000018066 . 61–64. 10026404 . 21334983 .
  13. Gao . Qian-Qian . Xi . Ming-Rong . Yao . Qiang . Impetigo Herpetiformis during Pregnancy: A Case Report and Literature Review . Dermatology . S. Karger AG . 226 . 1 . 2013 . 1018-8665 . 10.1159/000346578 . 35–40. 23446290 . 42999570 .
  14. Patsatsi . Aikaterini . Theodoridis . Theodoros D. . Vavilis . Dimitrios . Tzevelekis . Vasilios . Kyriakou . Aikaterini . Kalabalikis . Dimitrios . Sotiriadis . Dimitrios . Cyclosporine in the Management of Impetigo Herpetiformis: A Case Report and Review of the Literature . Case Reports in Dermatology . S. Karger AG . 5 . 1 . March 23, 2013 . 1662-6567 . 10.1159/000350564 . 99–104. 23626548 . 3635965 .
  15. Luan . Li . Han . Shixin . Zhang . Zhenying . Liu . Xiaoming . Personal treatment experience for severe generalized pustular psoriasis of pregnancy: two case reports . Dermatologic Therapy . Hindawi Limited . 27 . 3 . December 10, 2013 . 1396-0296 . 10.1111/dth.12112 . 174–177. 24517287 . 37248288 .
  16. Tintinger . G. R. . Anderson . R. . Feldman . C. . Pharmacological approaches to regulate neutrophil activity . Seminars in Immunopathology . Springer Science and Business Media LLC . 35 . 4 . March 15, 2013 . 1863-2297 . 10.1007/s00281-013-0366-8 . 395–409. 23494251 . 253808218 .

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