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.

Figure 1

Psoriasis herpeticum. Erythematous scaly plaques with peripheral hyperpigmentation involving the (a) face, scalp, (b–d) torso, and extremities, with scattered ~1 cm erosions.

Figure 2

Psoriasis herpeticum. Punch biopsy specimen of the left leg demonstrating (a) psoriasiform acanthosis, epidermal necrosis, and acantholysis with (b) multinucleate keratinocytes with margination of chromatin and nuclear molding (hematoxylin-eosin stain; original magnification: (a) ×40; (b) ×400).

Figure 3

Psoriasis herpeticum. Biopsy specimen from Figure 2 showing positivity with HSV type I immunoperoxidase staining (herpes simplex virus type I immunoperoxidase stain; original magnification: ×200).