Antenatal - Rashes in pregnancy

Question 1

what is this rash?

Answer 1

polymorphic eruption of pregnancy

itchy rash that often starts in the 3rd trimester

usually begins on the abdomen and is associated with striae

characterised by urticarial papules, wheals, plaques

usually improves towards the end of pregnancy and after delivery

management - topical emollients, topical steroids, oral antihistamines, oral steroids in severe cases

Question 2

what is this rash?

Answer 2

atopic eruption of pregnancy

eczema that flares up during pregnancy - including both women that have never suffered with eczema and those with pre-exisitng eczema

presents in 1st and 2nd trimester

2 types:
E type = eczematous, inflamed, red, itchy typically affecting insides of the elbows, knees, neck, face and chest

P-type = intensely itch papules typically affecting abdomen, back and limbs

improves after delivery

management - topical emollients, topical steroids, phototherapy with UVB, oral steroids in severe cases

Question 3

what is this rash?

Answer 3

melasma

increased pigmentation to patches of the skin on the face - symmetrical and flat, affecting sun exposed areas

partly due to increased female sex hormones associated with pregnancy, can also occur with COCP and HRT

no active treatment required

management - avoid sun exposure, makeup, skin lightening cream (not in pregnancy), chemical peels or laser treatment

Question 4

what is this rash?

Answer 4

pyogenic granuloma

lobular capillary haemangioma

benign, rapidly growing tumour of capillaries

discrete red lump with red or dark appearance

occur more in pregnancy and hormonal contraceptives

triggered by minor trauma or infection

fingers, upper chest, back, neck, head

may bleed

need to exclude malignancy - but usually resolve by themselves after pregnancy

Tx - surgical removal and histology

Question 5

what is this rash?

Answer 5

rare autoimmune skin condition that occurs in pregnancy

cause epidermis and dermis to separate and fill with fluid resulting in large fluid-filled blisters

usually 2nd or 3rd trimester

itchy red papular or blistering rash around umbilicus that then spreads to other parts of the body. over several weeks, large fluid filled blisters form

usually resolves without treatment after delivery

treatment - topical emollients, topical steroids, oral steroids may be required in severe cases, immunosuppressants may be required where steroids are inadequate, abx may be necessary if infection

risks to baby - FGR, preterm, blistering rash after delivery as maternal antibodies pass to baby

Question 6

what is this rash?

Answer 6

linea nigra

due to placental hormones

usually fades over time after delivery

advised to avoid sun exposure