Facial rash with exuberant crusting in pregnancy.

Abstract

Case Summary A woman in her 20s with a history of systemic lupus erythematosus controlled with azathioprine and low-dose prednisone presented at ten weeks of pregnancy after developing pruritic, painful facial lesions over three weeks. She had no history of rosacea, topical corticosteroid use, or recent fevers, but was wearing masks frequently. On examination, she appeared nontoxic and had numerous coalescing erythematous papules and pustules with yellow-gray crusting around her nose, mouth, and glabella (Fig. 1). The vermilion border was spared. No comedones were present. Herpes simplex virus polymerase chain reaction (PCR), varicella zoster virus PCR, bacterial cultures, and fungal cultures were negative. Punch biopsy of a pustule showed intraepidermal neutrophilic spongiosis with subcorneal pustules, diffuse dermal neutrophilic inflammation, and dermal edema.