8.19 Pregnancy-related Rashes Flashcards
Name 5 rashes that can appear in pregnancy
Polymorphic eruption of pregnancy
Atopic eruption of pregnancy
Melasma
Pyogenic granuloma
Pemphigoid gestations
What is another name for polymorphic eruption of pregnancy?
pruritic and urticarial papules and plaques of pregnancy
What is this?
Polymorphic eruption of pregnancy
What is this?
Atopic eruption of pregnancy
What is this?
Melasma
What is this?
Pyogenic granuloma
What is this?
Pemphigoid gestations
Where and when does polymorphic eruption of pregnancy start?
starts in the 3rd trimester begins on abdomen and is associated with stretch marks
What appearance characterises polymorphic eruption of pregnancy?
- Urticarial papules (raised itchy lumps) - Wheals (raised itchy areas of skin) - Plaques (larger inflamed areas of skin)
How do you manage polymorphic eruption of pregnancy?
Gets better towards the end of pregnancy, control symptoms:
- Oral Antihistamines
- Topical emollients
- Topical steroids
- Oral steroids may be used in severe cases
What is atopic eruption of pregnancy? When does it appear?
Essentially eczema flare up during pregnancy (can occur in pre-existing or first time eczema). Presents in 1st and 2nd trimester of pregnancy.
What is the difference between the two types of atopic eruption of pregnancy?
E-type, or eczema-type:
- eczematous, inflamed, red and itchy skin,
- typically insides of the elbows, back of knees, neck, face and chest.
P-type, or prurigo-type:
- intensely itchy papules (spots)
- typically affecting the abdomen, back and limbs.
Management of atopic eruption of pregnancy?
- Phototherapy with ultraviolet light (UVB) may be used in severe cases
- Topical emollients
- Topical steroids
- Oral steroids may be used in severe cases
What is Melasma also known as? Appearance?
“mask of pregnancy” aka chloasma (which means green) increased pigmentation on patches of face, symmetrical, flat, sun exposed areas
What causes Melasma?
increase female sex hormones –> increased pigmentation
also associated with:
- sun exposure
- FHx
- thyroid disease
Can also occur with:
- COCP
- HRT
Management of melasma?
- if pregnancy related then tends to fade after birth
- avoid sun and use suncream
- makeup to cover it
- skin lightening cream (hydroquinone or retinoid cream) but not during pregnancy
- chemical peals / laser but not on NHS
What is another name for Pyogenic granuloma?
lobular capillary haemangioma
What is a Pyogenic granuloma and how does it present?
- benign rapidly growing tumour of capillaries
- discrete red lump
- often on fingers (or back, neck or head)
- 1 or 2cm or bigger
- bleed and ulcer if injured
What is an important differential for pyogenic granuloma?
malignancy like nodular melanoma
Treatment of pyogenic granuloma?
usually resolve after pregnancy - can surgically remove and histology to confirm Dx
When do pemphigoid gestations occur and what do they look like?
- occur in second or third trimester
- itching red, papular, blistering rash
- near umbilicus
- spreads to other parts
- large fluid filled blisters can form
What causes pemphigoid gestations?
- rare autoimmune skin condition of pregnancy
- autoantibodies cause layers of dermis and epidermis to separate
- antibodies may be in response to placental tissue
What are the risk to baby of pemphigoid gestations?
- Fetal growth restriction
- Preterm delivery
- Blistering rash after delivery (as the maternal antibodies pass to the baby)
How do you manage pemphigoid gestations?
- will usually resolve after delivery
- Topical emollients
- Topical steroids
- Oral steroids may be required in severe cases
- Immunosuppressants where steroids are inadequate
- Antibiotics if infection occurs
