19 - 105 - SKIN CHANGES AND DISEASES IN PREGNANCY

Question 1

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

Answer 1

A

Question 2

Most common structural change in pregnancy

a. Melasma

b. Linea nigra

c. Striae

d. Molluscum fibrosum gravidarum

Answer 2

C

Question 3

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

Answer 3

B

Question 4

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

Answer 4

C

Question 5

The ff. are associated with pemphigoid gestationis, except:

a. SGA

b. Premature delivery

c. Choriocarcinoma

d. Stillbirths

Answer 5

D

Question 6

Give examples of dermatoses associated with fetal risk in pregnancy

Answer 6

• Pemphigoid gestationis
• Intrahepatic cholestasis of pregnancy
• Pustular psoriasis of pregnancy

Question 7

Question 8

intensely pruritic, vesiculobullous eruption of mid- to late pregnancy and the immediate postpartum period

Answer 8

Pemphigoid (herpes) gestationis (PG)

Question 9

What is the fetal risk of pemphigoid gestationis

Answer 9

PG is associated with an increased incidence of small-for-gestational age births and premature delivery.

Question 10

Includes the periumbilical skin

Answer 10

Pemphigoid (herpes) gestationis (PG)

Question 11

Most common physiologic change in pregnancy

Answer 11

Pigmentary disturbances

Question 12

T/F: Significant change in nevi size is not a feature of most pregnancies.

Answer 12

True

Question 13

most common structural change during pregnancy

Answer 13

striae distensae, also known as striae gravidarum

Question 14

most common vascular lesion to develop in pregnancy

Answer 14

Spider angiomas

Question 15

What are the dermatoses associated with fetal risk in pregnancy

Answer 15

1. Pemphigoid gestationis
2. Intrahepatic cholestasis of pregnancy
3. Pustular psoriasis of pregnancy

Question 16

Lacks primary cutaneous lesions

Answer 16

Intrahepatic cholestasis of pregnancy

Question 17

Question 18

intensely pruritic, vesiculobullous eruption of mid- to late pregnancy and the immediate postpartum period

Answer 18

Pemphigoid (herpes) gestationis (PG)

Question 19

Pemphigoid gestationis is associated with what fetal risk

Answer 19

small-for-gestational age births and premature delivery.

Question 20

This pregnancy dermatosis includes the periumbilical skin

Answer 20

Pemphigoid gestationis

Question 21

During which stage in pregnancy does Intrahepatic cholestasis of pregnancy (ICP) occur?

Answer 21

late pregnancy, when serum concentrations of estrogen reach their peak.

Question 22

Question 23

only pregnancy dermatosis that presents without primary skin lesions

Answer 23

Intrahepatic cholestasis of pregnancy (ICP)

Question 24

Question 25

single most sensitive indicator of ICP

Answer 25

Elevation in serum bile acids

Question 26

Total serum bile acid levels greater than ___ are consistent with ICP.

Answer 26

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

Question 27

In ICP, the cholic acid-to-chenodeoxycholic acid ratio is ________

Answer 27

greater than 1.5 (reference range: 0.7 to 1.5)

Question 28

In ICP, the cholic acid proportion of total bile acids is ________

Answer 28

greater than 42%

Question 29

In ICP, the glycine conjugates-to-taurine conjugates of bile acids ratio is _______

Answer 29

< 1 (reference range: 0.9 to 2)

Question 30

In ICP, the glycocholic acid concentration is ________

Answer 30

greater than 2 µM (reference range: 0.6 to 1.5 µM)

Question 31

hallmark of ICP

Answer 31

symptoms and associated biochemical abnormalities typically resolve within 2 to 4 weeks of delivery

Question 32

Clinical course and prognosis of ICP

Answer 32

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.

Question 33

Fetal risks in ICP

Answer 33

increased rates of prematurity, fetal distress, and fetal death

Question 34

Treatment of choice for ICP

Answer 34

ursodeoxycholic acid (UDCA), a naturally occurring hydrophilic bile acid

Question 35

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.

Answer 35

PUSTULAR PSORIASIS OF PREGNANCY (IMPETIGO HERPETIFORMIS)

Question 36

Life-threatening maternal complications of pustular psoriasis of pregnancy

Answer 36

hypocalcemia and bacterial sepsis. Rarely, tetany, delirium, and convulsions occur if hypocalcemia is severe.

Question 37

most feared complications of pustular psoriasis of pregnancy

Answer 37

placental insufficiency and consequent stillbirth or neonatal death

Question 38

most common laboratory derangements in pustular psor of preg

Answer 38

leukocytosis, neutrophilia, an elevated erythrocyte sedimentation rate, hypoferric anemia, and hypoalbuminemia

Question 39

Question 40

Cardinal feature of pustular psoriasis of pregnancy

Answer 40

rapid resolution of symptoms after delivery

Question 41

First-line therapy for pustular psor of preg

Answer 41

cyclosporine 5 - 10 mg/kg and infliximab

Question 42

In pustular psor of preg, this is an option when symptoms do not remit despite supportive and pharmacologic therapy

Answer 42

Induction of labor

Question 43

DERMATOSES NOT ASSOCIATED WITH FETAL RISK IN PREGNANCY

Answer 43

1. Polymorphic eruption of pregnancy (previously pruritic urticarial papules and plaques of pregnancy) 2. Atopic eruption of pregnancy (AEP)

Question 44

Polymorphic eruption of pregnancy (PEP) is a common, benign, intensely pruritic dermatosis that occurs almost exclusively in ___________

Answer 44

primigravidas during the third trimester and immediate postpartum period

Question 45

With sparing of umbilicus

Answer 45

Question 46

Clinical features of PEP

Answer 46

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.

Question 47

Question 48

Question 49

most common pruritic disorder in pregnancy

Answer 49

ATOPIC ERUPTION OF PREGNANCY

Question 50