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Subcorneal pustular dermatosis: Comprehensive review and report of a case presenting during pregnancy

ABSTRACT: Subcorneal pustular dermatosis (SPD), also known as Sneddon-Wilkinson disease, is a rare, relapsing, sterile pustular eruption of unknown etiology that develops most commonly in middle-aged or mature women. This article reviews the presentation, associations, and management of the condition and highlights advances in pathophysiology. Onset of SPD during pregnancy has not been reported. Herein, we report a case of SPD that developed during pregnancy. The patient was treated with dapsone without complications for her or the fetus. An association between T helper (Th) 17 and Th2 environments in the development of SPD has been advocated. Pregnancy is characterized by a predominance of Th2 responses and increased interleukin-17 levels and thus may favor the development of the condition.

SUBMITTER: Bhargava S

PROVIDER: S-EPMC7330443 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Subcorneal pustular dermatosis: Comprehensive review and report of a case presenting during pregnancy

Bhargava Shashank S Kumar Ujjwal U Kroumpouzos George G

International journal of women's dermatology 20200220 3

Subcorneal pustular dermatosis (SPD), also known as Sneddon-Wilkinson disease, is a rare, relapsing, sterile pustular eruption of unknown etiology that develops most commonly in middle-aged or mature women. This article reviews the presentation, associations, and management of the condition and highlights advances in pathophysiology. Onset of SPD during pregnancy has not been reported. Herein, we report a case of SPD that developed during pregnancy. The patient was treated with dapsone without c ...[more]

PMID: 32637535

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Project description:ImportanceErosive pustular dermatosis (EPD) is a rare condition that typically affects actinically damaged skin of the scalp. Characterized by sterile pustules, erosions, and crusts, EPD is difficult to treat and heals slowly. The exact cause of EPD is unknown, although trauma is an inciting factor.ObjectiveTo describe 3 women who presented with prolonged facial erosions after cosmetic resurfacing procedures, specifically fully ablative carbon dioxide laser or medium-depth chemical peel.Design, setting, and participantsThis case series describes the clinical features, histopathological findings, laboratory results, and treatment of 3 patients with an ultimate diagnosis most consistent with facial EPD. Patients were evaluated between September 10, 2010, and May 6, 2016, in a dermatology clinic in an academic medical center. The patients were 3 women seeking diagnostic evaluation and therapeutic options for nonhealing facial erosions occurring after ablative procedures (carbon dioxide laser resurfacing or Jessner solution/trichloroacetic acid chemical peel).Main outcomes and measuresHistologic examination and wound culture from initial presentation as well as clinical follow-up documenting improvement with therapeutic interventions.ResultsAll 3 patients were women in their 50s or 60s for whom EPD was deemed to be the best diagnosis, after infection, immunobullous disorders, and other pustular dermatoses were considered. Histologic features were nonspecific. Treatment included a combination of topical and systemic therapies, such as corticosteroids, dapsone, isotretinoin, and/or antibiotics. Watchful waiting (tincture of time) appeared to be central to the healing process.Conclusions and relevanceAfter cosmetic resurfacing, patients may develop EPD isolated to the face. As a diagnosis of exclusion that should be considered in patients who have nonhealing wounds following ablative procedures, EPD is challenging to treat and may require the use of anti-inflammatory agents. Recognizing this condition is important, especially as cosmetic procedures become more widespread.

Project description:Introduction and importance: Generalized pustular psoriasis of pregnancy (GPPP) is a rare dermatosis that causes maternal and fetal morbidity and mortality. Pustular psoriasis of pregnancy (PPP) is a challenging dermatological Condition, which can have impact on the life pregnant woman's and her unborn child's life. Case presentation Here we report a 26-year-old woman with a history of persistent plaque psoriasis presented with generalized pustular lesions. Ultrasonography revealed normal fetal development despite high serum ESR and CRP levels. Pustular psoriasis was confirmed by histopathology. The patients were given systemic prednisolone 32 mg once daily, which was raised to 60 mg once daily on the tenth day of treatment to manage fresh outbreaks, and the patient's rash continued to gradually improve. When the lesions faded after 4 weeks of treatment, the dose was reduced to 16 mg/day. At 31 weeks' gestation, the patient was discharged and she was kept on prednisolone at a low dose of 4 mg once daily for the duration of the pregnancy. Clinical discussion Generalized pustular psoriasis of pregnancy (GPPP), herpetiformis, is a less common form dermatosis that can be fatal for both mother and the fetus. Response to treatment is good when initiated early in the course of the disease. This present case shows young pregnant mother with GPPP successfully treated with systemic corticosteroid. Conclusion Contrary to the majority of other common pregnant dermatosis, pustular psoriasis is an uncommon condition that can have harmful effects on the fetus. Our patient's PPP symptoms included systemic ones as well as body and palm involvement. Close monitoring and administration of systemic corticosteroids ensured secure outcomes. Highlights • Generalized pustular psoriasis (GPPP) is a rare dermatosis that causes maternal and fetal morbidity and mortality.• This case illustrates a woman that had history of psoriasis vulgaris two years before pregnancy and developed pustular psoriasis type.• Systemic corticosteroids are regarded as the gold standard in the treatment of GPPP.• In this paper, we will present the case report of 26 year old pregnant woman who developed widespread pustular lesions in the 27th week of her fifth pregnancy.

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Subcorneal pustular dermatosis: Comprehensive review and report of a case presenting during pregnancy

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Subcorneal pustular dermatosis: Comprehensive review and report of a case presenting during pregnancy

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