Psoriasis is most commonly of the chronic plaque variety. In contrast, with generalized pustuar psoriasis of pregnancy, severe systemic symptoms may develop. Formerly called impetigo herpetiformis, this rare pustular form has erythematous, sometimes pruritic plaques ringed by sterile pustules that enlarge and then crust (Fig. 62-3). Lesions initially involve intertriginous areas but may spread to the torso, extremities, and oral mucosa. Comorbid constitutional symptoms are common. Laboratory testing may reveal hypocalcemia, elevated erythrocte sedimentation rate, leukocytosis, and hypoalbuminemia (Lehrhof, 2013). Extensive lesions can lead to sepsis from secondary infection and to massive fluid loss with hypovolemia and placental insuiciency. First-line treatment is with oral prednisone, cyclosporine, infliximab, topical corticosteroids, or topical calcipotriene (Robinson, 2012). Phototherapy is a second-line option. For secondary infections, intravenous antibiotics are added (Huang, 2011). Pustular psoriasis typically resolves quickly in the puerperium, but recurrences have been reported in subsequent pregnancies and with menstruation or oral contraceptive use (Roth, 2011).
his skin condition represents inflammation of subcutaneous fat associated with numerous disorders, including pregnancy. Other triggers are infections, sarcoidosis, drugs, Beh:et syndrome, inlammatory bowel disease, or a malignancy (Mert, 2007; Papagrigoraki, 2010). Characteristically, 1-to 6-cm tender, red, warm nodules and plaques develop rapidly on the extensor surface of the legs and arms. Within a few days, lesions flatten and undergo the color evolution of a bruise-from dark red and purple to yellow green. Constitutional symptoms may also be present. Initial evaluation and treatment focuses on the underlying etiology. Symptoms spontaneously resolve in 1 to 6 weeks without scarring but may leave residual hyperpigmentation (Acosta, 2013).
his lesion is frequently seen in pregnancy (Fig. 62-4). Poorly named, pyogenic granuloma is actually a lobular capillary hemangioma commonly forming on the mouth or hand in response to low-grade local irritation or traumatic injury. hey grow
FIGURE 62-3 Generalized pustular psoriasis of pregnancy displays FIGURE 62-4 Pyogenic granuloma is characterized grossly by a erythematous, sometimes pruritic plaques ringed by sterile pustules lobulated red growth on a pedunculated or sessile base. With minithat enlarge and then form a scaling crust. (Used with permission mal trauma, these vascular lesions bleed easily. (Used with permisfrom Dr. Paul Slocum.) sion from Dr. Abel Moron.) quickly and bleed with minimal provocation. Active bleeding can be controlled with pressure and application of a silver nitrate stick or Monsel paste (ferric subsulfate). These growths often resolve within months postpartum. But with a symptomatic antepartum growth, a persistent postpartum lesion, or with an unclear diagnosis, excision can be done using suture and scalpel, electrosurgical curettage, laser photocoagulation, or cryotherapy. Oral lesions are best referred to oral health-care specialists.