Authors: Marie Len A. Camaclang, MD, Ma Lorna F. Frez, MD, FPDS


Introduction: Annular pustular psoriasis is a rare variant of pustular psoriasis characterized by annular erythematous plaques with pustular margins. To date, there have been no reports of annular pustular psoriasis in pregnancy. It tends to run a subacute to chronic course with little to no associated systemic toxicities, compared to the more commonly described zumbusch type. We report the first documented case of subacute annular pustular psoriasis in a six-week G5P4(4004) pregnant patient with a history of chronic stable plaque-type psoriasis.

Case Summary: This is a case of a 32-year-old Filipino female who presented with multiple erythematous plaques and pustules, associated with generalized weakness and undocumented fever. She is a known clinical case of chronic stable plaque-type psoriasis. On physical examination, there were multiple well-defined, annular to circinate thick scaly plaques, with multiple discrete to coalescing pustules studding the margins, on a background of erythema, generally distributed on the trunk and extremities. Urine test confirmed pregnancy at approximately six weeks age of gestation. She reportedly had unremarkable past pregnancies. A skin biopsy showed psoriasiform dermatitis and subcorneal pustule formation consistent with pustular psoriasis. Baseline laboratory tests were normal. The patient was started on short-course topical steroid, and narrowband UVB phototherapy.

Conclusion: Psoriasis patients may exhibit worsening or exacerbation of their lesions during pregnancy, as this case has illustrated. When presented with pustular psoriasis in pregnancy, it is important to differentiate the annular type from the zumbusch type, which may occasionally be life-threatening. Nevertheless, immediate management is indicated and remains guarded.





psoriasis, annular pustular, pregnancy

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