II. Epidemiology
- Rare pregnancy-related disorder
III. Pathophysiology
- Generalized Pustular Psoriasis variant specific to pregnancy
IV. Symptoms
- Rash develops in third trimester
- No Pruritus
- Contrast with nearly every other specific cause of Skin Conditions of Pregnancy
- See Pruritus in Pregnancy
- Systemic symptoms may develop (related to complications)
V. Signs: Skin
-
Pustular Psoriasis
- Starts as Pustules
- Pustular lesions coalesce into Plaques
- Plaques desquamate
- Lesion Distribution
- Starts in the intertriginous areas (e.g. inguinal and axillary folds)
- Spreads centrifugally to the extremities
- Spares the face, palms and soles
- Associated Findings
VI. Management
- Increased antepartum observation (fetal surveillance)
- High dose Systemic Corticosteroids
- Prednisone 20-60 mg daily with taper
- Severe cases
-
Antibiotics
- As indicated for secondary Skin Infections
VII. Complications: Maternal
- Secondary Bacterial Infection (may be systemic)
- Hyperparathyroidism
- Hypocalcemia
- Hypoalbuminemia
VIII. Complications: Fetus
- Adverse fetal outcomes
- Placental insufficiency
- Fetal demise
IX. Course
- Onset in third trimester of pregnancy
- Resolves after delivery
- May recur with future pregnancies