Generalised pustular psoriasis of pregnancy (GPPP) is a rare dermatosis that presents in the third trimester. It merits careful clinical assessment given the difficulty in diagnosis, impact on maternal health and association with placental insufficiency. We present a case of generalised pustulosis in a pregnant woman at 30 weeks' gestation and describe the clinico-pathological challenges in obtaining a diagnosis of GPPP. Furthermore, we provide evidence from cardiotocography and ultrasound of evolving fetal compromise and describe how intensive management can facilitate a positive maternal–fetal outcome.
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