II. Epidemiology

  1. Rare pregnancy-related disorder

III. Pathophysiology

  1. Generalized Pustular Psoriasis variant specific to pregnancy

IV. Symptoms

  1. Rash develops in third trimester
  2. No Pruritus
    1. Contrast with nearly every other specific cause of Skin Conditions of Pregnancy
    2. See Pruritus in Pregnancy
  3. Systemic symptoms may develop (related to complications)
    1. Nausea or Vomiting
    2. Diarrhea
    3. Fever and chills

V. Signs: Skin

  1. Pustular Psoriasis
    1. Starts as Pustules
    2. Pustular lesions coalesce into Plaques
    3. Plaques desquamate
  2. Lesion Distribution
    1. Starts in the intertriginous areas (e.g. inguinal and axillary folds)
    2. Spreads centrifugally to the extremities
    3. Spares the face, palms and soles
  3. Associated Findings
    1. Lymphadenopathy

VI. Management

  1. Increased antepartum observation (fetal surveillance)
  2. High dose Systemic Corticosteroids
    1. Prednisone 20-60 mg daily with taper
  3. Severe cases
    1. Cyclosporine
    2. Infliximab (TNF Inhibitor)
    3. UVB Phototherapy
  4. Antibiotics
    1. As indicated for secondary Skin Infections

VII. Complications: Maternal

  1. Secondary Bacterial Infection (may be systemic)
  2. Hyperparathyroidism
  3. Hypocalcemia
  4. Hypoalbuminemia

VIII. Complications: Fetus

  1. Adverse fetal outcomes
  2. Placental insufficiency
  3. Fetal demise

IX. Course

  1. Onset in third trimester of pregnancy
  2. Resolves after delivery
  3. May recur with future pregnancies

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