Infliximab for the treatment of recalcitrant generalized pustular psoriasis of pregnancy: Report of a challenging case.

Pustular psoriasis of pregnancy (PPP), also known as impetigo herpetiformis, is a rare gestational dermatosis that may induce life-threatening complications for both the mother and fetus. Treatment of recalcitrant generalized PPP may be challenging as available therapeutic options are limited. We herein present a 24-year-old pregnant woman with generalized PPP accompanied by high fever, fatigue, leukocytosis, and elevated levels of serum acute phase reactants. The patient was resistant to high-dose cyclosporine (7.5 mg/kg/day, peroral), systemic methylprednisolone (1 mg/kg/day, intramuscular), and empirical antibiotherapy. However, she dramatically responded to infliximab (5 mg/kg, intravenous infusion), which was introduced at the 28th gestational week. Even within 24 hours after the first infusion of infliximab, pustular lesions began to regress combined with a rapid decline in fever. Following the third infusion, clearance of pustular lesions with a slight erythema was observed. Serum levels of leukocytes and acute phase reactants returned to normal. There were no adverse events related to infliximab therapy. At the 40th gestational week, the patient gave birth to a healthy baby. Our experience reported herein suggests that infliximab may serve as a rapidly acting, highly effective, and well-tolerated "rescue" therapy in recalcitrant generalized PPP, which poses a big therapeutic challenge for clinicians. This article is protected by copyright. All rights reserved.