Chapter 28 - Pregnancy Dermatoses

Question 1

True or false: there’s an increased risk for prematurity and small-for-gestational-age births in mothers with pemphigoid gestationis.

Answer 1

True

Question 2

What is the autoantibody in pemphigoid gestationis?

Answer 2

BP180

Question 3

What HLA types are associated with gestational pemphigoid?

Answer 3

HLA DR3 and DR4

Question 4

When during pregnancy does gestational pemphigoid present?

Answer 4

Classically during late pregnancy, but it can also present post-partum

Question 5

Can newborns be affected by gestational pemphigoid?

Answer 5

Yes; up to 10% develop blistering, but the disease tends to be mild and self-limited

Question 6

True or false: systemic steroids can cause placental calcification and small-for-gestional-age babies.

Answer 6

True

Question 7

What type of patient is most at risk for PUPPP?

Answer 7

Primiparous women who experience rapid and excessive weight gain during pregnancy

Question 8

Where on the body do the lesions of PUPPP typically begin?

Answer 8

On the abdomen, within abdominal striae

Question 9

True or false: in biopsies of skin affected by PUPPP, there is usually a linear band of C3 along the basement membrane zone on DIF.

Answer 9

False; in PUPPP the DIF is negative; in gestational pemphigoid there will be a linear band of C3 along the basement membrane zone

Question 10

True or false: like in PUPPP, the primary lesions of cholestasis of pregnancy are urticarial papules.

Answer 10

False; there are no primary lesions in cholestasis of pregnancy

Question 11

What risk is there to newborns born to mothers with cholestasis of pregnancy?

Answer 11

Increased risk of meconium staining and fetal distress

Question 12

True or false: viral hepatitis is more common during pregnancy than cholestasis of pregnancy, and must be excluded.

Answer 12

True

Question 13

What are the 4 pruritic entities of pregnancy?

Answer 13

1) Pemphigoid gestationis, 2) pruritic urticarial papules & plaques of pregnancy (PUPP), 3) prurigo of pregnancy, 4) cholestasis of pregnancy

Question 14

At which trimester does pemphigoid gestationis present?

Answer 14

T3, immediate postpartum

Question 15

What is the pathogenesis of PG?

Answer 15

Anti-BMZ factor (herpes gestationis factor, anti-BPAG2/collagen XVII Ab) that causes C3 deposition along DEJ

Question 16

What are the possible neonatal complications with PG?

Answer 16

Prematurity, SGA, bullous lesions at birth, no effect on morbidity/mortality. Mothers are at risk of subsequently developing Graves disease, but have no other risks!

Question 17

What defines cholestasis of pregnancy? Hint: there are 5 criteria

Answer 17

1) generalized pruritus with no hx of viral hepatitis or hepatotoxic drugs, 2) no primary lesions, 3) biochemical findings consistent with cholestasis, 4) resolves after pregnancy, 5) recurrence with subsequent pregnancies

Question 18

What is the % of recurrence with subsequent pregnancies in cholestasis of pregnancy?

Answer 18

60-70%

Question 19

What is the treatment for cholestasis of pregnancy?

Answer 19

Cholestyramine, phenobarbital, UVB, rest, low fat diet, ursodeoxycholic acid (15mg/kg/d)

Question 20

What are some physiologic changes during pregnancy?

Answer 20

Hyperpigmentation, melasma, hirsutism, telogen effluvium, androgenetic alopecia, subungual hyperkeratosis, onycholysis, nail grooving/brittleness, increased sweating/sebum, striae, spider angiomas, palmar erythema, non-pitting edema, varicosities, vasomotor instabiliy, purpura, gingival hyperemia/hyperplasia, pyogenic granuloma, hemorrhoids

Question 21

When does the dermatitis flare in autoimmune progesterone dermatitis?

Answer 21

Luteal phase

Question 22

What is the treatment for PG?

Answer 22

Prednisone 0.5mg/kg PO daily (S/E: placental calcifications, low birth weight), Class II or lower topical steroid, cyclosporine

Question 23

What is the most common pregnancy-specific dermatoses?

Answer 23

PUPPP (pruritic urticarial papules & plaques of pregnancy)

Question 24

How do you diagnosis PUPPP?

Answer 24

Diagnosis of exclusion. Rule out urticarial pemphigoid gestationis although do not suggest IF/ELISA testing in classic cases of PUPPP

Question 25

True/False: PUPPP can be associated with maternal or fetal morbidity.

Answer 25

False

Question 26

What is prurigo of pregnancy also known as?

Answer 26

snier’s prurigo gestationis, Nurse’s early onset prurigo of pregnancy, Spangler’s papular dermatitis of pregnancy, pruritic folliculitis, linear IgM disease of pregnancy

Question 27

What is the 1st and 2nd most common cause of gestational jaundice?

Answer 27

Viral hepatitis, cholestasis of pregnancy