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August 2000

Recurrent Pustular Rash in a Pregnant Woman

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Arch Dermatol. 2000;136(8):1055-1060. doi:

A biopsy specimen revealed hyperkeratosis and spongiosis of the epidermis, with intracorneal neutrophilic microabscesses. A superficial perivascular and interstitial infiltrate of lymphocytes and neutrophils was noted. The findings of direct immunofluorescence studies and Gram and periodic acid–Schiff staining were negative.

Four days after consultation, high-dose systemic steroid therapy was initiated. Despite treatment with l mg/kg per day of methylprednisolone, the patient continued to worsen, with extension and progression of skin lesions and increased weakness. Labor was induced at 28 weeks' gestation, with successful delivery of a 1210-g viable boy and Apgar scores of 6 at 1 minute and 8 at 5 minutes. The neonate did not have skin lesions. The mother's skin markedly improved after delivery, along with normalization of the white blood cell count. The calcium levels were stable. No postpartum complications were noted. The mother's eruption cleared within 1 month of delivery, without residual scarring.

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