Pregnancy is a time full of many skin changes. You may notice acne breakouts, stretch marks, and spider and varicose veins. If you have eczema or psoriasis, those conditions can get worse, too.
Pregnancy can also cause another, more dangerous condition called impetigo herpetiformis. It’s a form of generalized pustular psoriasis (GPP). It’s very rare. But if it happens, it can be life threatening for both you and your baby, says Chicago dermatologist Carolyn Jacob, MD. Here’s what you need to know.
What Is Impetigo Herpetiformis?
When GPP occurs during pregnancy, it's called impetigo herpetiformis. It’s a form of psoriasis that causes pus filled bumps, or pustules over large areas of your body. While there are no specific statistics on how common it is in pregnant people, it does make up only about 4% of all cases of skin disease during pregnancy.
Since GPP during pregnancy is very dangerous, it needs to be treated as soon as possible, says Jacob.
What Causes GPP During Pregnancy?
The exact cause of GPP during pregnancy is unclear. Many people who develop it have a past history of psoriasis or a family history of it. Hormonal fluctuations in estrogen and progesterone are thought to be potential triggers, says Shoshana Marmon, MD, PhD, an assistant professor in the department of dermatology at New York Medical College in Valhalla, New York. “Genetic predisposition, particularly mutations in the IL36RN gene, and immune changes during pregnancy may also play a role in its development,” she says.
Some pregnant people with GPP also have low levels of calcium, vitamin D, parathyroid hormone, and elafin, a protein produced naturally by your skin, says Jacob.
What Are the Signs of GPP During Pregnancy?
GPP usually happens in the third trimester. Symptoms include:
- Small pustules that start in skin folds like your inner elbows and behind your knees, then spread to your trunk and around your belly button. They may also show up in your mouth and on your tongue.
- Fever
- GI upset like vomiting or diarrhea
What Are the Best Treatments for GPP During Pregnancy?
Since GPP during pregnancy is so rare, there aren’t a lot of treatment guidelines. Your doctor will most likely want to do a skin biopsy to confirm the diagnosis. They’ll run blood tests to check your white blood cell count as well as markers of inflammation, such as a high erythrocyte sedimentation rate. They’ll also want to see if your calcium and electrolytes are elevated.
If you’re diagnosed with GPP, you may worry whether it’s safe to take medication to treat it. “If you have a GPP flare, rapid intervention is important,” says Jeffrey Cohen, MD, director of the Psoriasis Treatment Program at Yale Medicine in New Haven, Connecticut. Your treatment selection will usually be based on the severity of your flare, he says.
A short course of steroids is usually the first treatment, says Marmon. These drugs are considered generally safe to use during pregnancy. Doctors usually prescribe oral prednisolone at high doses for a few days. They then taper it slowly as you get better. You’ll be watched carefully to make sure your GPP doesn’t flare up again.
If this doesn’t work, your doctor may prescribe low-dose cyclosporine. It’s a drug that suppresses your immune system. It’s thought to be fairly safe in pregnant people, but it can cause you to give birth early or have a baby with a low birth weight. Another option is the drug infliximab (Remicade). It’s a biologic often used to treat GPP that appears to be safe to use during pregnancy. You may need to stay on it for the rest of your pregnancy to prevent another flare, says Cohen.
Another option that’s safe during pregnancy is phototherapy. It uses UV light to clear the GPP on your skin. It may be added if you don’t get enough help from oral steroids. One type of phototherapy, ultraviolet light B (UVB), may lower your folate levels. While you don’t need to worry about that if you’re in your third trimester, you may want to avoid it earlier in your pregnancy. Another option is PUVA. It uses ultraviolet light A along with psoralens, which are light-sensitizing agents. It appears to be safe, although it has been linked to lower birth weights.
Regardless of your GPP treatment, you’ll be watched carefully for signs of dehydration. Your doctor may want to run blood tests frequently to check your electrolyte and calcium levels too, says Marmon. If they’re abnormal, you may need to be hospitalized until they are under control.
A new biologic medicine was recently FDA approved to treat acute flares of GPP. It’s called spesolimab (Spevigo). But this medicine hasn’t been tested in pregnancy.
How Does GPP Affect Both Mother and Baby?
It can be very dangerous for both of you. For mothers, it can lead to:
- Electrolyte abnormalities
- Dehydration
- Severe infection
- Sepsis, a life-threatening condition where your body attacks its own organs.
It’s also dangerous for babies. If you have GPP, you can develop placental insufficiency. This means that your placenta is not able to deliver enough blood, oxygen, and other nutrients to your baby. This can cause:
- Miscarriage or stillbirth
- Preterm labor
- Low birth weight
Even if your GPP is well controlled, you and your baby will still be watched carefully throughout your pregnancy.
Future GPP Flares
GPP often goes away once you give birth. If it doesn’t, your doctor may prescribe either methotrexate (Otrexup (PF), Rasuvo, Xatmep) or oral retinoids. These both work well to treat GPP, but they aren’t safe to take during pregnancy. You’re more likely to develop GPP in future pregnancies, though. Your doctor will continue to monitor you closely if you get pregnant again.
Show Sources
Photo Credit: iStock/Getty Images
SOURCES:
Carolyn Jacob, MD, Chicago dermatologist, associate professor of dermatology, Northwestern Medical School, Chicago, Illinois.
Shoshana Marmon, MD, PhD, assistant professor, department of dermatology, New York Medical College, Valhalla, New York.
Jeffrey Cohen, MD, director, Psoriasis Treatment Program, Yale Medicine in New Haven, Connecticut.
UptoDate: “Dermatoses of Pregnancy.”
Dermatology Research & Practice: “Impetigo Herpetiformis: Review of Pathogenesis, Complication, and Treatment.”
International Journal of Women’s Health: “Pustular Psoriasis of Pregnancy: Current Perspectives.”
ACOG: “Skin Conditions During Pregnancy.”
Clinical Case Reports: “Pustular Psoriasis of Pregnancy in Early First Trimester: A Case Report.”
Science Direct: “Impetigo Herpetiformis–An Overview.”
