19 - 105 - SKIN CHANGES AND DISEASES IN PREGNANCY Flashcards
The ff. glandular changes in pregnancy are true, except:
a. Increased apocrine function
b. Increased sebaceous function
c. Increased thyroid activity
d. Increased eccrine function
A
Most common structural change in pregnancy
a. Melasma
b. Linea nigra
c. Striae
d. Molluscum fibrosum gravidarum
C
GLG is a 28 year old female, G1P0, currently on 36 weeks age of gestation. She came in due to an eruption or pruritic erythematous papules and plaques which started on the abdomen with noted periumbilical sparing. Later similar lesions spread to her thighs and buttocks. Which of the
a. Atopic eruption or pregnancy
b. Polvmorphic eruption or pregnancy
c. Impetigo herpetiformis
d. Pemphigoid gestationis
B
All are TRUE about Atopic Eruption of Pregnancy, EXCEPT?
a. There are 2 types: E-type & P-type
b. Comprises approximately 50% of all pregnancy dermatoses, making it the most common pruritic disorder In pregnancy
c. Recurrence with subsequent pregnancies is uncommon
d. In a mother with a known history of atopy, the infant will be at increased risk for atopic dermatitis
C
The ff. are associated with pemphigoid gestationis, except:
a. SGA
b. Premature delivery
c. Choriocarcinoma
d. Stillbirths
D
Give examples of dermatoses associated with fetal risk in pregnancy
- Pemphigoid gestationis
- Intrahepatic cholestasis of pregnancy
- Pustular psoriasis of pregnancy
intensely pruritic, vesiculobullous eruption of mid- to late pregnancy and the immediate postpartum period
Pemphigoid (herpes) gestationis (PG)
What is the fetal risk of pemphigoid gestationis
PG is associated with an increased incidence of small-for-gestational age births and premature delivery.
Includes the periumbilical skin
Pemphigoid (herpes) gestationis (PG)
Most common physiologic change in pregnancy
Pigmentary disturbances
T/F: Significant change in nevi size is not a feature of most pregnancies.
True
most common structural change during pregnancy
striae distensae, also known as striae gravidarum
most common vascular lesion to develop in pregnancy
Spider angiomas
What are the dermatoses associated with fetal risk in pregnancy
- Pemphigoid gestationis
- Intrahepatic cholestasis of pregnancy
- Pustular psoriasis of pregnancy
Lacks primary cutaneous lesions
Intrahepatic cholestasis of pregnancy
intensely pruritic, vesiculobullous eruption of mid- to late pregnancy and the immediate postpartum period
Pemphigoid (herpes) gestationis (PG)
Pemphigoid gestationis is associated with what fetal risk
small-for-gestational age births and premature delivery.
This pregnancy dermatosis includes the periumbilical skin
Pemphigoid gestationis
During which stage in pregnancy does Intrahepatic cholestasis of pregnancy (ICP) occur?
late pregnancy, when serum concentrations of estrogen reach their peak.
only pregnancy dermatosis that presents without primary skin lesions
Intrahepatic cholestasis of pregnancy (ICP)
single most sensitive indicator of ICP
Elevation in serum bile acids
Total serum bile acid levels greater than ___ are consistent with ICP.
11 µM/L
In healthy pregnant women, total bile acids are slightly elevated above baseline and levels as high as 11 are accepted as normal in late pregnancy
In ICP, the cholic acid-to-chenodeoxycholic acid ratio is ________
greater than 1.5 (reference range: 0.7 to 1.5)
In ICP, the cholic acid proportion of total bile acids is ________
greater than 42%
In ICP, the glycine conjugates-to-taurine conjugates of bile acids ratio is _______
< 1 (reference range: 0.9 to 2)
In ICP, the glycocholic acid concentration is ________
greater than 2 µM (reference range: 0.6 to 1.5 µM)
hallmark of ICP
symptoms and associated biochemical abnormalities typically resolve within 2 to 4 weeks of delivery
Clinical course and prognosis of ICP
Recurrences during subsequent pregnancies occur in an estimated 45% to 70% of patients. Some women experience recurrent ICP after exposure to oral contraceptives or to contraceptive aids, such as synthetic estrogens and progestational agents.
Maternal outcomes are generally favorable, although women with severe cases are predisposed to postpartum hemorrhage secondary to vitamin K depletion.
Fetal risks in ICP
increased rates of prematurity, fetal distress, and fetal death
Treatment of choice for ICP
ursodeoxycholic acid (UDCA), a naturally occurring hydrophilic bile acid
characterized by an acute eruption occurring as early as the first trimester, but generally during the third trimester, of an otherwise uneventful pregnancy
The condition manifests as erythematous patches whose margins are studded with subcorneal pustules.
The eruption typically originates in flexural areas, spreads centrifugally and sometimes generalizes.
PUSTULAR PSORIASIS OF PREGNANCY (IMPETIGO HERPETIFORMIS)
Life-threatening maternal complications of pustular psoriasis of pregnancy
hypocalcemia and bacterial sepsis. Rarely, tetany, delirium, and convulsions occur if hypocalcemia is severe.
most feared complications of pustular psoriasis of pregnancy
placental insufficiency and consequent stillbirth or neonatal death
most common laboratory derangements in pustular psor of preg
leukocytosis, neutrophilia, an elevated erythrocyte sedimentation rate, hypoferric anemia, and hypoalbuminemia
Cardinal feature of pustular psoriasis of pregnancy
rapid resolution of symptoms after delivery
First-line therapy for pustular psor of preg
cyclosporine 5 - 10 mg/kg and infliximab
In pustular psor of preg, this is an option when symptoms do not remit despite supportive and pharmacologic therapy
Induction of labor
DERMATOSES NOT ASSOCIATED WITH FETAL RISK IN PREGNANCY
- Polymorphic eruption of pregnancy (previously pruritic urticarial papules and plaques of pregnancy)
- Atopic eruption of pregnancy (AEP)
Polymorphic eruption of pregnancy (PEP) is a common, benign, intensely pruritic dermatosis that occurs almost exclusively in ___________
primigravidas during the third trimester and immediate postpartum period
With sparing of umbilicus
Clinical features of PEP
Polymorphous in nature, lesions may be urticarial (most commonly), vesicular, purpuric, polycyclic, targetoid, or eczematous in appearance (Fig. 105-7). 34 Typical lesions are 1- to 2-mm erythematous urticarial papules surrounded by a narrow pale halo. The eruption begins on the abdomen, classically within the striae gravidarum, and demonstrates periumbilical sparing.
most common pruritic disorder in pregnancy
ATOPIC ERUPTION OF PREGNANCY
