Pruritic postpartum eruption
Our patient initially blamed the lesions on the surgical tape used after her C-section; a skin biopsy told another story.
Treat with topical corticosteroids and systemic antihistamines
The goal of treatment for PG is to provide relief from the pruritus and to decrease and suppress blister formation. Topical corticosteroids, such as clobetasol or betamethasone, and systemic antihistamines, such as cetirizine, can be used to treat mild cases of PG. First-generation antihistamines are favored over second-generation antihistamines because of their increased safety when used during pregnancy.
Severe cases. Oral steroids are used for patients with more severe cases of PG. The preferred corticosteroid is prednisolone, typically starting at 20 to 40 mg/d or 0.5 to 1 mg/kg/d and adjusting as needed.5 For patients who do not respond to corticosteroids or for whom corticosteroids are contraindicated, intravenous immunoglobulins or plasmapheresis may be beneficial.5 If a patient requires postpartum treatment, the possibility of medications being passed through breast milk needs to be considered.
Our patient. We prescribed clobetasol 0.05% ointment for our patient and told her to apply it twice daily to the affected areas. We discussed the possibility of using a systemic corticosteroid, but she opted to use the topical medication exclusively because she was breastfeeding. Although our patient still gets an occasional blister when she is stressed, they go away 1 to 2 days after she applies the clobetasol ointment.
CORRESPONDENCE
Sarah Groff, MD, University of Texas Health Science Center at San Antonio, 7979 Wurzbach Road, San Antonio, TX 78229; groff@uthscsa.edu.
