Hi all,

This is my third go round with fulminans. First occurrence in my first pregnancy, 2nd time as the result of a steroid flare and now, pregnant again. I am going to use this space to document my treatment in the hopes that it will help someone else, there is very little documentation on fulminans, esp in pregnancy, and Derms tend to be clueless on this topic so maybe this will be helpful.

History:
3rd presentation of fulminans occurred at approx 15 weeks of pregnancy as P&P on right cheek, rapidly progressing. 1st Derm I saw told me it wasn't possible for a recurrence of fulminans (ha!) and prescribed metrogel. I was traveling and the P&P were progressing so I called his office and he prescribed 10mgs of prednisone over the phone with a long taper

2 weeks into the new dose of prednisone the flare worsened so I saw a new Derm who is better than the previous Derm but is still kind of an ass (why? Why must dermatologist be jerks? Is it in the handbook in med school!?) I gave him the history and notes from my previous pregnancy, he gave me the exact same dosage as I had in 2006, starting at 40 mgs of prednisone with a loooong taper. I am now down to 10mgs. Initially I saw improvement and then the flare worsened as I tapered down to 20mgs. He also prescribed finacea which hurts to use but appears to be reducing some of the swelling.

I returned to the doctor and he now has me on 1000mgs of zithromax (class b and approved by my Ob) for the duration of my pregnancy and am continuing to taper off the prednisone. The flare is worse than it has ever has been covering my right cheek completely and my left cheek partially.

I am also on the following meds: lovenox 40mgs daily (blood thinner for complications in this pregnancy) which, I am sure, is contributing to the flare as I would imagine more blood flow equals more P&P and swelling. Neevo DhA (prenatal), probiotics due to the ridiculous amount of antibiotics, 5000iu of d3 and a lot of Tylenol.

Interestingly i have been diagnosed with a genetic mutation i am homozygous for the MTHFTHR mutation c667ct which is why I am on lovenox. Not sure if this related to the fulminans but thought I'd put it out there in case there any researchers reading.

Beyond all the drugs, I am also doing dombeoro soaks 1x daily, I find them very drying. I sleep with polysporin on my P&P ams have recently added on the silcon scar away pads in the hopes that I can minimize scarring this time around.

Today I tried the hydrogen peroxide and baking soda regime mentioned by ghost and others out of curiosity to see if it would dry up the P&P faster than the dombeoro. I wash my face with cetaphil and do a lot of cold water face baths. I am allergic to sulfa and have been told by numerous derms that my face will react to sulfer lotion and washes so that avenue of treatment is out for me. Doxy, accutane etc are class d, or worse, for pregnancy so also not options. Ditto for retin-a or any vitamin a derivative.

I won't lie. This is hard. I am trying to keep on a brave face but when my 6 year old says "what's wrong with your face mommy" it's hard. He still tells me he loves me though, so, that's something

I will post updates and maybe some pictures as I can.