Hydroxychloroquine-induced Impetigo Herpetiformis Managed with Oral Cyclosporine: A Rare Case Report

Hydroxychloroquine-induced Impetigo Herpetiformis Managed with Oral Cyclosporine: A Rare Case Report

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Impetigo Herpetiformis (IH), or Generalised Pustular Psoriasis (GPP) of pregnancy, is a rare gestational dermatosis that lacks the usual triggers for pustular psoriasis and is often associated with adverse maternal and foetal outcomes.The onset typically occurs in vibrating table for chocolate the third trimester and hormonal fluctuations during pregnancy might play a role in the pathogenesis.Hypocalcaemia, hypoalbuminaemia and hypoparathyroidism are often associated with this condition.A characteristic resolution of symptoms typically occurs after delivery, with a tendency for recurrence in subsequent pregnancies.

Genetic susceptibility and mutations in the gene encoding the interleukin 36 receptor antagonist may constitute significant underlying pathology.Acute Generalised Exanthematous Pustulosis (AGEP) closely resembles this condition both clinically and histopathologically and should be ruled out to ensure appropriate treatment.Drug-induced cases are seldom reported and those arising from Hydroxychloroquine (HCQ) are even rarer.The patient in the present case is a 33-year-old primiparous female in her second trimester, with a history of recurrent miscarriage for which she was prescribed HCQ prophylactically.

However, 15 days later, she presented with itchy erythematous patches all over her body, which later evolved into a generalised pustular eruption.Histopathological examination revealed a large sub-corneal pustule filled with neutrophils and neutrophilic debris.A diagnosis of HCQ-induced IH read more was made and the patient was managed successfully with cyclosporine monotherapy.HCQ, a routinely used medication for a number of conditions, is considered safe in pregnancy; however, clinicians should be aware that it can cause IH.

Early immunotherapy with cyclosporine is a safe and effective option to control the disease without the need to add glucocorticoids, thereby preventing the burden of additional adverse effects.