title: Management of Psoriasis Herpeticum in Pregnancy: A Clinical Conundrum.
abstract: Introduction.Kaposi varicelliform eruption (KVE) is a widespread cutaneous viral infection, most commonly herpes simplex virus, which affects patients with underlying dermatosis. When KVE occurs in a patient with a history of psoriasis, it is referred to as psoriasis herpeticum, a rare subtype of KVE with only a handful of cases reported in the literature. To the authors' knowledge, we report for the first time a case of psoriasis herpeticum in pregnancy.Case Presentation.A 23-year-old woman in her third pregnancy presented at 26-week gestation with a 10-year history of psoriasis. Cutaneous examination revealed diffuse psoriatic plaques with scattered ~1 cm erosions. Punch biopsy of the skin revealed herpes simplex virus (HSV) infection within a psoriatic plaque, necessitating dermatological treatment. The patient experienced premature rupture of membranes at 37-week gestation. Pelvic exam showed no evidence of herpetic lesions. After labor augmentation, the patient delivered a healthy female infant with no evidence of HSV infection.Discussion.Psoriasis herpeticum is a rare and potentially devastating complication of an underlying dermatosis. With a paucity of data available to guide pregnancy-specific issues, the general management of this condition is controversial and requires a multidisciplinary care approach. Concerns for systemic infection in the mother and vertical transmission to the neonate are of critical importance.
authors.affiliation: Department of Obstetrics and Gynecology, Detroit Medical Center, Wayne State University, 3990 John R., 7 Brush N., Detroit, MI 48201, USA.
authors.forename: Leanne
authors.identifier: 0000-0001-9618-1958
authors.initials: L
authors.lastname: Almario
authors.affiliation: Department of Dermatology, Henry Ford Health System, 3031 West Grand Boulevard, Suite 800, Detroit, MI 48202, USA.
authors.forename: Albert S
authors.initials: AS
authors.lastname: Antonyan
authors.affiliation: Department of Dermatology, Henry Ford Health System, 3031 West Grand Boulevard, Suite 800, Detroit, MI 48202, USA.
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Porto
authors.affiliation: Department of Obstetrics and Gynecology, Detroit Medical Center, Wayne State University, 3990 John R., 7 Brush N., Detroit, MI 48201, USA.
authors.forename: Hunter
authors.initials: H
authors.lastname: Gomez-Roberts
authors.affiliation: Department of Obstetrics and Gynecology, Detroit Medical Center, Wayne State University, 3990 John R., 7 Brush N., Detroit, MI 48201, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Alhousseini
authors.affiliation: Department of Obstetrics and Gynecology, Detroit Medical Center, Wayne State University, 3990 John R., 7 Brush N., Detroit, MI 48201, USA.
authors.forename: Bernard
authors.identifier: 0000-0002-6464-7079
authors.initials: B
authors.lastname: Gonik