The current Ebola outbreak has drawn attention to the virus in the medical community. Zaire ebolavirus, more commonly known as ‘the Ebola virus,’ is a level 4-security agent in the Filoviridae family. The main cutaneous finding of Ebola is a nonspecific maculopapular rash that appears between day four and six of disease. Patients have “ghost-like” features, and the rash initially presents on the upper arms, flexor forearms, and upper legs, sometimes in a centripetal fashion. Skin biopsy, immunohistochemistry, ELISA, and electron microscopy can help provide early diagnosis and conceivably prevent spread if proper precautionary measures are in place.

Objectives

To investigate prospectively how psoriasis fluctuates in pregnancy and post partum and to correlate hormone levels in pregnancy (progesterone and estrogens) with psoriatic change.

Design

Psoriatic body surface area (BSA) in pregnant patients with psoriasis (study group) and nonpregnant, menstruating patients with psoriasis (control group) were assessed 5 times over a year. Hormone levels (progesterone and estrogens) were measured in the study group and correlated with change in BSA.

Setting

University-affiliated obstetric and dermatology clinics.

Patients

Forty-seven pregnant patients in the psoriasis group and 27 nonpregnant, menstruating patients in the control group.

Results

During pregnancy, 55% of the patients reported improvement, 21% reported no change, and 23% reported worsening. However, post partum, only 9% of patients reported improvement, 26% reported no change, and 65% reported worsening. Psoriatic BSA decreased significantly from 10 to 20 weeks' gestation (P<.001) compared with controls, whereas BSA increased significantly by 6 weeks post partum (P = .001) compared with controls. In patients with 10% or greater psoriatic BSA who reported improvement (n = 16; mean BSA, 40%), lesions decreased by 83.8% during pregnancy. There were significant or near significant correlations between improvement in BSA and estradiol (P = .009, r = 0.648), estriol (P = .06, r = 0.491), and the ratio of estrogen to progesterone (P = .006, r = 0.671).

Conclusion

High levels of estrogen correlated with improvement in psoriasis, whereas progesterone levels did not correlate with psoriatic change.

Idiopathic pure sudomotor failure (IPSF) is a rare disease characterized by acquired impairment in total body sweating despite exposure to heat or exercise. Its etiology is unknown but thought to involve defective cholinergic receptors on eccrine sweat glands. This article reviews the epidemiology, pathophysiology, presentation, and management of IPSF. Additionally, we report two cases of IPSF treated with multimodal therapy, including stacked antihistamine regimens and omalizumab, resulting in symptom improvement. This is the first report of treatment of IPSF with omalizumab, although its benefit is uncertain and requires further study.