8.19 Pregnancy-related Rashes

Question 1

Name 5 rashes that can appear in pregnancy

Answer 1

Polymorphic eruption of pregnancy

Atopic eruption of pregnancy

Melasma

Pyogenic granuloma

Pemphigoid gestations

Question 2

What is another name for polymorphic eruption of pregnancy?

Answer 2

pruritic and urticarial papules and plaques of pregnancy

Question 3

What is this?

Answer 3

Polymorphic eruption of pregnancy

Question 4

What is this?

Answer 4

Atopic eruption of pregnancy

Question 5

What is this?

Answer 5

Melasma

Question 6

What is this?

Answer 6

Pyogenic granuloma

Question 7

What is this?

Answer 7

Pemphigoid gestations

Question 8

Where and when does polymorphic eruption of pregnancy start?

Answer 8

starts in the 3rd trimester begins on abdomen and is associated with stretch marks

Question 9

What appearance characterises polymorphic eruption of pregnancy?

Answer 9

• Urticarial papules (raised itchy lumps) - Wheals (raised itchy areas of skin) - Plaques (larger inflamed areas of skin)

Question 10

How do you manage polymorphic eruption of pregnancy?

Answer 10

Gets better towards the end of pregnancy, control symptoms:

• Oral Antihistamines
• Topical emollients
• Topical steroids
• Oral steroids may be used in severe cases

Question 11

What is atopic eruption of pregnancy? When does it appear?

Answer 11

Essentially eczema flare up during pregnancy (can occur in pre-existing or first time eczema). Presents in 1st and 2nd trimester of pregnancy.

Question 12

What is the difference between the two types of atopic eruption of pregnancy?

Answer 12

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.

Question 13

Management of atopic eruption of pregnancy?

Answer 13

• Phototherapy with ultraviolet light (UVB) may be used in severe cases
• Topical emollients
• Topical steroids
• Oral steroids may be used in severe cases

Question 14

What is Melasma also known as? Appearance?

Answer 14

“mask of pregnancy” aka chloasma (which means green) increased pigmentation on patches of face, symmetrical, flat, sun exposed areas

Question 15

What causes Melasma?

Answer 15

increase female sex hormones –> increased pigmentation

also associated with:

• sun exposure
• FHx
• thyroid disease

Can also occur with:

• COCP
• HRT

Question 16

Management of melasma?

Answer 16

• 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

Question 17

What is another name for Pyogenic granuloma?

Answer 17

lobular capillary haemangioma

Question 18

What is a Pyogenic granuloma and how does it present?

Answer 18

• 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

Question 19

What is an important differential for pyogenic granuloma?

Answer 19

malignancy like nodular melanoma

Question 20

Treatment of pyogenic granuloma?

Answer 20

usually resolve after pregnancy - can surgically remove and histology to confirm Dx

Question 21

When do pemphigoid gestations occur and what do they look like?

Answer 21

• occur in second or third trimester
• itching red, papular, blistering rash
• near umbilicus
• spreads to other parts
• large fluid filled blisters can form

Question 22

What causes pemphigoid gestations?

Answer 22

• rare autoimmune skin condition of pregnancy
• autoantibodies cause layers of dermis and epidermis to separate
• antibodies may be in response to placental tissue

Question 23

What are the risk to baby of pemphigoid gestations?

Answer 23

• Fetal growth restriction
• Preterm delivery
• Blistering rash after delivery (as the maternal antibodies pass to the baby)

Question 24

How do you manage pemphigoid gestations?

Answer 24

• 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