A 28-year-old female with a long history of psoriasis develops symmetrical, flexural and grouped pustules with high grade fever and severe constitutional symptoms in the third trimester.
(i) What is your diagnosis?
(ii) How do you manage the condition?
(iii) What are the complications?
(i) Diagnosis
The condition is Generalized Pustular Psoriasis of Pregnancy (GPPP), also called Impetigo Herpetiformis. It is a rare, severe form of pustular psoriasis, usually arising in the third trimester and resolving after delivery. It presents with symmetrical sterile pustules on an erythematous base, often beginning in flexures, and systemic features like fever, chills, nausea, and malaise. A history of psoriasis is an important predisposing factor.
(ii) Management
Management requires hospitalization and multidisciplinary care. Systemic corticosteroids (oral prednisone 0.5–1 mg/kg/day) are the mainstay and considered relatively safe in late pregnancy. Supportive care includes correction of fluids/electrolytes, fever control, emollients, antiseptic washes, and adequate nutrition. Fetal monitoring with non-stress tests and scans is essential. Antibiotics are used if secondary infection is suspected. In refractory cases, cyclosporine or biologics may be considered cautiously; delivery may be required for uncontrolled disease.
(iii) Complications
Maternal risks: sepsis, electrolyte imbalance, renal failure, hypocalcemia, respiratory or cardiac failure.
Fetal risks: growth restriction, prematurity, distress, stillbirth, or neonatal death.
Answered By:
Sakshi Negi
Sakshi Negi is a Delhi-based journalist and content specialist with expertise in educational content and digital media, focusing particularly on government exam preparation and career guidance. With a degree in Journalism and Mass Communication from NRAI School of Mass Communication and her background as a Kendriya Vidyalaya alumna, she brings unique insights into the Indian education system and government sector opportunities.
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