Infliximab for the treatment of recalcitrant generalized pustular psoriasis of pregnancy: Report of a challenging case

Abstract

Pustular psoriasis of pregnancy (PPP), also known as impetigo herpetiformis, is a rare gestational dermatosis that may induce life‐threatening complications for both the mother and fetus. Treatment of recalcitrant generalized PPP may be challenging as available therapeutic options are limited. We herein present a 24‐year‐old pregnant woman with generalized PPP accompanied by high fever, fatigue, leukocytosis, and elevated levels of serum acute phase reactants. The patient was resistant to a combination treatment of high‐dose cyclosporine (7.5 mg/kg/d, peroral), systemic methylprednisolone (1 mg/kg/d, intramuscular), and empirical antibiotherapy. However, she dramatically improved with infliximab (5 mg/kg, intravenous infusion), which was introduced at week 28 of pregnancy. Even within 24 hours after the first infusion of infliximab, pustular lesions began to regress with a rapid decline in fever. Following the third infusion, clearance of pustular lesions with a slight erythema was observed. Serum levels of leukocytes and acute phase reactants returned to normal. There were no adverse events related to infliximab therapy. At 40 weeks, the patient gave birth to a healthy baby. Our experience reported herein suggests that infliximab may serve as a rapidly acting, highly effective, and well‐tolerated “rescue” therapy in recalcitrant generalized PPP, which poses a big therapeutic challenge for clinicians.

Use of biologic therapies for psoriasis during pregnancy and long‐term outcomes of exposed children: A 14‐year real‐life experience at a tertiary center in Turkey and review of the literature

“…As all patients were in clinical remission (PASI = 0), treatment was discontinued upon the diagnosis of pregnancy. On the other hand, one patient developed recalcitrant generalized PPP during the third trimester of three consecutive pregnancies, which was successfully treated with infliximab (as previously reported), 20 adalimumab, and secukinumab, respectively. None of the patients experienced any adverse events related to biologic therapy.…”

Pustular psoriasis of pregnancy: Clinical and genetic characteristics in a series of eight patients and review of the literature

“…The literature search identified 83 articles, only 35 were ultimately selected 5–39 . The corresponding results are summarized in Table 2.…”

“…The mean of the gestational age at the onset was 26 ± 5.2 GW in the present cohort similar to the literature. In fact, PPP often occurs in the last trimester of pregnancy [6][7][8][9][14][15][16]20,21,[24][25][26][27]30,32,35,37 but occurrence in the second trimester is not rare. [10][11][12]15,[17][18][19]23,28,29,31,33,34,36,39 Early onset at the first trimester of pregnancy is unusual and was reported only in three patients with no history of GPP.…”

“…Pustular psoriasis of pregnancy (PPP) conditions Literature (39P) Current study (8 P) Flares number 41 15 Onset disease mean age (years) 27 23 Personal history of psoriasis 13 [5,7,10,11,14,15,17,20,31,34,36,39] 4…”

“…7 Biotherapy was not used in our series, while in the current literature review; it was used in many case reports during the pregnancy or in post-partum period. Different molecules were used like Infliximab (5 mg/kg), 14 Adalimumab (40-80 mg), 15 Ustekinumab (45-90 mg) 5,12 and Secukinumab (150-300 mg). 10 Patients treated with these molecules showed an improvement with no reported side effects.…”