2011 Volume 121 Issue 4 Pages 705-714
We describe two cases of generalized pustular psoriasis (GPP), whose disease activity was exacerbated during their first pregnancy. Case 1: A 19-year-old woman with a 5-year history of psoriasis vulgaris presented with scaly erythematous plaques accompanied by pustules on the abdomen, extending over the entire body at 28 weeks gestation. Because of a high-grade fever and elevated inflammatory state, she was treated initially with oral PSL (30 mg/day) with a partial improvement of the skin lesion, followed by safe tapering to a daily dose of PSL (15 mg/day). At 36 weeks gestation, she gave birth to a low birth weight boy (2,360 g) by caesarean section. Four months later, oral CyA was helpful for flare-up of the rash. Case 2: A 35-year-old woman with a long history of controllable GPP since infancy and being treated with CyA (2.5 mg/kg/day) became pregnant. She had a highgrade fever and extensive pustular erythema on her trunk at 20 weeks gestation. Her clinical symptoms responded poorly to the increased dose of CyA (4 mg/kg/day), but improved gradually when combined with a high dose of PSL (up to 50 mg/day). She delivered a healthy boy (3,098 g) at 39 weeks gestation (PSL 10 mg/day and CyA 4 mg/kg/day), and her disease activity was under control with the same treatment regimen. Our two cases had never experienced embryotoxicity, teratogenicity, or resultant abortion in association with high-risk treatments during pregnancy, such as systemic corticosteroids and immunosuppressive agents. We review similar case series in the literature and also discuss the potential difficulty of medical intervention for pregnant women with life-threatening, aggressive GPP.
