Chapter 28 - Pregnancy Dermatoses Flashcards
True or false: there’s an increased risk for prematurity and small-for-gestational-age births in mothers with pemphigoid gestationis.
True
What is the autoantibody in pemphigoid gestationis?
BP180
What HLA types are associated with gestational pemphigoid?
HLA DR3 and DR4
When during pregnancy does gestational pemphigoid present?
Classically during late pregnancy, but it can also present post-partum
Can newborns be affected by gestational pemphigoid?
Yes; up to 10% develop blistering, but the disease tends to be mild and self-limited
True or false: systemic steroids can cause placental calcification and small-for-gestional-age babies.
True
What type of patient is most at risk for PUPPP?
Primiparous women who experience rapid and excessive weight gain during pregnancy
Where on the body do the lesions of PUPPP typically begin?
On the abdomen, within abdominal striae
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.
False; in PUPPP the DIF is negative; in gestational pemphigoid there will be a linear band of C3 along the basement membrane zone
True or false: like in PUPPP, the primary lesions of cholestasis of pregnancy are urticarial papules.
False; there are no primary lesions in cholestasis of pregnancy
What risk is there to newborns born to mothers with cholestasis of pregnancy?
Increased risk of meconium staining and fetal distress
True or false: viral hepatitis is more common during pregnancy than cholestasis of pregnancy, and must be excluded.
True
What are the 4 pruritic entities of pregnancy?
1) Pemphigoid gestationis, 2) pruritic urticarial papules & plaques of pregnancy (PUPP), 3) prurigo of pregnancy, 4) cholestasis of pregnancy
At which trimester does pemphigoid gestationis present?
T3, immediate postpartum
What is the pathogenesis of PG?
Anti-BMZ factor (herpes gestationis factor, anti-BPAG2/collagen XVII Ab) that causes C3 deposition along DEJ
What are the possible neonatal complications with PG?
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!
What defines cholestasis of pregnancy? Hint: there are 5 criteria
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
What is the % of recurrence with subsequent pregnancies in cholestasis of pregnancy?
60-70%
What is the treatment for cholestasis of pregnancy?
Cholestyramine, phenobarbital, UVB, rest, low fat diet, ursodeoxycholic acid (15mg/kg/d)
What are some physiologic changes during pregnancy?
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
When does the dermatitis flare in autoimmune progesterone dermatitis?
Luteal phase
What is the treatment for PG?
Prednisone 0.5mg/kg PO daily (S/E: placental calcifications, low birth weight), Class II or lower topical steroid, cyclosporine
What is the most common pregnancy-specific dermatoses?
PUPPP (pruritic urticarial papules & plaques of pregnancy)
How do you diagnosis PUPPP?
Diagnosis of exclusion. Rule out urticarial pemphigoid gestationis although do not suggest IF/ELISA testing in classic cases of PUPPP
True/False: PUPPP can be associated with maternal or fetal morbidity.
False
What is prurigo of pregnancy also known as?
snier’s prurigo gestationis, Nurse’s early onset prurigo of pregnancy, Spangler’s papular dermatitis of pregnancy, pruritic folliculitis, linear IgM disease of pregnancy
What is the 1st and 2nd most common cause of gestational jaundice?
Viral hepatitis, cholestasis of pregnancy
