A case of recurrent impetigo herpetiformis followed by delivery of a low birth weight infant

Abstract

In July 1998, a 26-year-old female visited us presenting skin lesions in both axillary areas, which appeared around the term of her first delivery and became worse gradually over a period of one month. She had dark red rice-grain sized papules with a scale-making annular arrangement in the axillary areas and military-sized papules at the flexor sides of her arms. Later she had military-sized pustules on her eruptions. A biopsy specimen revealed acanthosis with regular elongation of the rete ridges and subcorneal pustules, and she was diagnosed as pustular psoriasis at the time. Her skin lesions deteriorated and she was treated with 25 mg of oral prednisolone per day and PUVA. Both treatments had little effect and oral prednisolone was tapered. In June 1999, she was found to have periodontitis. After beginning dental treatment, no new eruptions appeared and oral prednisolone was stopped in May 2000. The eruptions recurred on her trunk and upper extremities in August 2001. She became pregnant with her second child in August 2002 ; since then pustules have appeared. She was treated only with corticosteroid ointments and the eruptions subsided. In May 2003, she delivered a low birth weight-child by Cesarean section and the skin lesions disappeared completely three months later. These findings strongly suggested a diagnosis of impetigo herpetiformis. Delivery of the low birth weight-child seems to be related to the severe impetigo herpetiformis she had from an early stage of the second pregnancy.