Cawe for diagnosis; Duhring's disease (dermatitis herpetiformis)? Impetigo herpetiformis? Moniliids?
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Impetigo herpetiformis is a rare and serious pustular eruption resembling pustular psoriasis that mostly occurs in pregnant women. The etiology of the disease is unclear and it is not known if genetic factors play a role. We present two sisters (twins) with impetigo herpetiformis supporting an inheritance pattern.
Impetigo herpetiformis (IH) is a rare pustular dermatosis with unknown aetiology, typically occurring during pregnancy. Based upon a similar clinical and histological presentation, i.e. spongiform accumulation of polymorphonuclear leucocytes in the stratum corneum, several authors consider IH as a variant of generalized pustular psoriasis (GPP), while others state that IH is a separate entity. Skin-derived antileucoproteinase (SKALP) is a strong and specific inhibitor of human leucocyte elastase (HLE) and proteinase 3, two neutral proteinases that have been implicated in leucocyte migration and tissue destruction. Previously, we reported decreased SKALP activity in pustular forms of psoriasis compared with plaque psoriasis. In this study we present a case study of a patient with IH, where SKALP activity was measured using biochemical and immunochemical techniques. Epidermal scales and sera were collected during the course of the disease. Comparison was made with three patients with GPP and six patients with plaque psoriasis. Initially, anti-HLE activity in epidermal scales of the patient with IH was comparable with values in patients with GPP, i.e. decreased compared with plaque psoriasis. During the course of the disease, anti-elastase activity dropped to undetectable levels, concomitant with the appearance of free elastase activity. This finding suggests a total saturation of epidermal anti-HLE activity. Low levels of SKALP, presumably complexed with HLE, could be measured immunochemically in scale extracts. Serum levels of total SKALP correlated with the disease activity. We suggest that a reduced amount of epidermal SKALP contributes to an imbalance between elastase and its inhibitor, resulting in the formation of epidermal pustules. This mechanism of pustule formation could apply both to GPP and IH, suggesting a final common pathway in the pathogenic mechanisms of IH and GPP.
Impetigo herpetiformis is a rare pustular disorder that occurs primarily in pregnancy and is often associated with hypocalcemia. The onset commonly presents in the last trimester of pregnancy; the condition may persist until delivery and it rarely continues in the postpartum period. There is an increase in morbidity and mortality for the mother and the fetus. As a result, immediate diagnosis and treatment is crucial. The purpose of this article is to delineate the clinical picture of this disease, its treatment, and the effect on the mother and the fetus.
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Impetigo herpetiformis, first described by Hebra, is a rare pustular disorder that primarily affects pregnant women and it is often complicated by an increased risk of spontaneous abortion. A commonly associated hypocalcemia often appears with hypoparathyroidism. Here we report a case of complicated impetigo herpetiformis without hypocalcemia paired with a compensatory hyperparathyroidism.
INTRODUCTION: Impetigo herpetiformis is a rare dermatitis that occurs during pregnancy and may be life threatening for both mother and child. In this case report, we present an Ondine curse involving the baby, and the good response to isotretinoine. CASE REPORT: A first pregnancy, 26 year-old woman developed at 8 months a widespread skin lesion involving the medial side of the thighs, abdomen and intertriginous areas, with a severe systemic toxic condition and fever. Diagnosis of impetigo herpetiformis was made and corticosteroids, methotrexate and cyclosporine were unsuccessful. Isotretinoine rapidly improved the patient with good control of the disease. The full term baby had an Ondine curse. DISCUSSION: Our case is typical of impetigo herpetiformis. Maternal and infant complication may be life threatening and we report a real Ondine curse the etiology of which remains unknown. Moreover, this observation is unusual because the lesions did not clear despite delivery and good treatment. In our opinion, the great improvement with isotretinoine would suggest it could be used as first line treatment.
Impetigo herpetiformis is a rare and often serious pustular dermatosis of pregnancy. The usual course of impetigo herpetiformis is one of continued progression throughout pregnancy with rapid resolution during the puerperium. This patient is the first reported case, to the authors' knowledge, of impetigo herpetiformis presenting during the puerperium, a time usually associated with the disease's remission. This suggests that impetigo herpetiformis should be included in the differential diagnosis of puerperal fever, particularly in those cases associated with dermatoses.
Impetigo herpetiformis and pustular psoriasis during pregnancy are distinct diseases. Pustular psoriasis during pregnancy is indistinguishable clinically, genetically, and histologically from pustular psoriasis in women who are not pregnant. Impetigo herpetiformis is not a heritable disorder and is not found particularly in persons with a personal or family history of psoriasis. Histologically in impetigo herpetiformis there are many large mononuclear cells in the dermis and in epidermal pustules. Proliferation of these mononuclear cells in the dermis is intense.
Impetigo herpetiformis is a rare non-infectious pustular dermatosis of pregnancy. A few non-gestational cases due to oral contraceptive use have also been reported. Although the disorder is not thought to have a genetic background, there are some familial case reports in the literature. We describe a case of recurrent impetigo herpetiformis in an 18-year-old pregnant woman who had normal serum calcium levels and responded well to prednisolone therapy. Interestingly, the patient's mother had also experienced a generalised pustular dermatosis associated with hypocalcaemia during oral contraceptive use, which was diagnosed clinically and histologically as impetigo herpetiformis.
Impetigo Herpetiformis is a rare pustular dermatosis that typically occurs in pregnant women with unknown etiology. A 17 year old patient who developed Impetigo Herpetiformis for the second time in the 27th week of her 2nd pregnancy is presented. The patient improved with corticosteroids treatment but the lesions did not clear completely and had flare ups during stressful periods which brings us to conclusion that Impetigo Herpetiformis at least has a common pathway with Generalized Pustular Psoriasis in the pathogenesis as stress provoked exacerbations.
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Two sisters (non-twins) had impetigo herpetiformis triggered by their first pregnancy. One sister treated with etretinate had good resolution of skin disease. Impetigo herpetiformis is probably a variant of pustular psoriasis and may be provoked or precipitated by factors, such as pregnancy. Both patients shared common HLA antigens (All, AW24, BW44, BW54 and DR6Y).
Impetigo herpetiformis is a rare acute eruption associated with severe systemic disturbances, typically occurring in pregnant women. We describe the case of a 33-year-old woman who presented with impetigo herpetiformis during her third pregnancy, the appearance of which coincided with an increase in the titer of E antigen antibodies.
A case of impetigo herpetiformis in pregnancy is reported together with a review of the literature. The patient was a 25-year-old primigravida with pregnancy-induced hypertension (PIH). At 35 weeks' gestation, the patient developed a severely pruritic pustular rash with fever and leukocytosis. The skin of the affected areas was biopsied and showed intraepidermal pustules with a neutrophilic infiltrate. Treatment commenced with intravenous fluids, oral prednisone, and steroid creams. Labor was induced, and a normal delivery of a healthy infant was effected, following which the patient's condition improved rapidly. The clinical and laboratory features were typical of impetigo herpetiformis as described in the literature. Impetigo herpetiformis is a rare, potentially serious skin disorder occurring particularly during pregnancy, and must be diagnosed early to allow prompt, aggressive treatment.
Impetigo herpetiformis is a rare pustular disorder affecting mainly pregnant women. We report a 16-yr-old adolescent primigravida, who presented with impetigo herpetiformis at 27 weeks gestation. She had a pustular erythroderma covering her entire body, except face, scalp, and palmoplantar regions, with severe pruritus and pain. After unsuccessful attempts of treatment with systemic corticosteroids, intravenous fluids, and antibiotics, treatment was switched to cyclosporine, but no therapeutic effect could be achieved. Because of the deteriorating condition of the patient, an early delivery decision was made. Her symptoms resolved after delivery, and at day 20 postpartum her skin lesions were completely resolved.
Impetigo herpetiformis (IH) is a rare dermatosis which usually occurs during the third trimester of pregnancy. It is characterized by acute erythematosquamous plaques covered with tiny superficial pustules in a herpetiform distribution with less likely mucus membranes involvement. It can be associated with constitutional symptom s such as fever, chills, nausea, vomiting and diarrhea. Impetigo herpetiformis can cause serious complications to the mother and fetus which include: maternal hypocalcemia leading to delirium, convulsions, and tetany in the mother, and placental insufficiency leading to still birth, neonatal death or fetal abnormalities. Lesions are expected to disappear after birth but may recur during subsequent pregnancies at an earlier gestational age. Presented here is a case of IH occurring during the 37th week of gestation in a primigravida who failed to respond to oral steroid but successfully cleared with oral etretinate.