The Burning Mother: Pustular Psoriasis with Anemia in Pregnancy: A Case Report

Abstract

Aim: To convey a detailed account of the successful management of a 36-week pregnant woman with pustular psoriasis, including the diagnostic process, treatment plan, and outcomes. To describe the challenges and considerations involved in managing psoriasis in pregnant women as well as the importance of a multidisciplinary approach to care. Background: Psoriasis affects 1–3% of the pregnant population worldwide and 2–3% of the pregnant population in India. Pustular psoriasis, a rare form of psoriasis in pregnancy may have significant adverse fetomaternal outcomes and require close surveillance throughout pregnancy. The management of generalized pustular psoriasis during pregnancy can be challenging for the treating physician. The unpredictability of the pregnancy outcome coupled with the lack of data on the safety of drugs to treat the disease can be a danger to public health. Hence, improving the fetal outcome by alleviating the symptoms of the mother while considering the risks of drugs is of utmost importance. Case description: Our case study highlights generalized pustular psoriasis in third-trimester pregnancy successfully treated with systemic steroids and cyclosporine. Systemic prednisolone 32 mg intravenous once a day and oral cyclosporine 2 mg/kg showed significant symptomatic improvement and controlled the flare-up. Timely intervention with decision to terminate pregnancy at 37 weeks by medical induction with strict fetal surveillance throughout the course of pregnancy has helped us achieve this outcome. Conclusion: Combination of systemic steroids and cyclosporin along with topical calcipotriol maybe used in severe cases. Also, physicians should be aware of the different course of outcomes in subsequent pregnancies in a patient with a known case of psoriasis as seen in our case study. Clinical significance: By sharing this case, it is hoped that healthcare professionals can gain insight into effective strategies for managing psoriasis in pregnant women, and ultimately improve patient outcomes.