Definite use of steroids in psoriasis (AIIMS Nov 2013)
1). Impetigo herpetiformis is a form of severe pustular psoriasis occurring in pregnancy. which may occur during any trimester.
2). There is still controversy in its classification. Some classify it as generalised pustular psoriasis of pregnancy, while others consider it as a distinct entity from psoriasis.
3). An early diagnosis is essential as the condition is life threatening and is associated with placental insufficiency and electrolytes abnormalities.
4). Impetigo herpetiformis can usually be successfully treated with topical and systemic corticosteroids. It is the only well-known pustular psoriasis which is treated with steroids.
5). Antibiotics may be indicated for secondary bacterial infection. Fluid and electrolytes especially calcium should be monitored and normalized.
6). Unresponsive cases can be given cyclosporine, narrowband ultraviolet B (NBUVB), psoralen ultraviolet A (PUVA, clofazimine)
7). Drugs of choice for pustular psoriasis is acitretin
8). Drugs of choice for psoriatic erythroderma methotrexate.