Derm Flashcards
What are defining characteristics of polymorphic eruption of pregnancy (PEP)/pruritic urticarial papule and placques of pregnancy (PUPPP)?
- excoriated papules that starts along abdominal striae
- spreads to thighs, buttocks, arms, legs
- spares periumbilical area (halo), face, palms, soles, mucous membranes
What does PEP/PUP typically present?
third tri or immediately postpartum
How is PEP/PUPPP treated?
- emollients
- topical corticosteroids
- PO antihistamine
- menthol
- typically resolves 1-6wks PP*
What are risks associated w/ PEP/PUPPP?
none
What are risk factors for PEP/PUPPP?
- atopic constitution (e.g. asthma, allergies, eczema)
- multiple gestation
- excessive weight gain
How is PEP/PUPPP dx’ed?
no dx testing
R/O PG, cholestasis
What are defining characteristics of prurigo of pregnancy (PP)?
- grouped, crusted, erythematous papules, patches, plaques; often excoriated
- extensor surface of arms, legs, abdomen
When does PP present?
b/w 25-30wks
What are PP differentials?
- pre-existing atopic s/sx
- scabies
- insect bites
- eczema
- drug-related rash
How is PP managed?
- topical corticosteroid cream
- PO antihistamine
- 3-10% urea emollient
- narrow band UVB tx
- typically resolves several weeks PP but may last for 12wks*
What are defining characteristics of pruritic folliculitis of pregnancy (PFP)?
- papules, pustules around hair follicles
- start on abdomen/trunk –> extremities
- +/- pruritus
When does PFP present?
rare
2nd or 3rd tri
What are differentials for PFP?
R/O
- PEP: no urticaria, lesions in striae
- PG: no bullous lesions
- acne: no lesions on face
- drug rxn
How is PFP managed?
- no pruritis = no tx
- symptomatic: topical steroid or UVB light
- resolves late in pregnancy or by 2wk PP*
What skin conditions does atopic dermatitis include?
- acne
- psoriasis
- eczema
What are defining characteristics of atopic dermatitis?
- lesions on UE/LE on flexor surfaces, trunk, hands, feet, nipples
- more widespread than in PP
- no primary lesions
- secondarily: erythema, scaling, lichenification, papules
- excoriation: oozing, weeping, secondary bacterial infection
When does atopic dermatitis present?
early in pregnancy - typically becomes worse during pregnancy in pts w/ pre-existing condition
What are risk factors for actopic dermatitis?
- hx of atopy
- family hx of atopy
- children w/ infantile atopic dermatitis
- African-American
- Asian
- smoking
How is atopic dermatitis managed?
- emollients
- PO antihistamines
- UV light
- mild topical steroids; PO steroids use sparingly, esp in 1st tri
What are defining characteristics of pemphigoid gestationis (PG)?
- severe pruritus
- urticarial, erythematous papules in periumbilical region and extremities
- not on face, palms, soles, mucous membranes
- papules change to placques –> form tense blisters (“bullous lesions”)
- blisters erupt –> yellow or hemorrhagic crust forms
What is the pathophysiology of PG?
autoimmune
IgG attacks transmembrane glycoprotein
begins in placenta; impacts skin
How is PG dx’ed?
- biopsy
- direct immunofluorescence (DIF) to detect C3 protein deposits –> r/o drug eruptions, contact dermatitis, bullous pemphigoid, erythema multiforme
- IgG presence
- ELISA to detect PG Abs
When does PG present?
rare
2nd and 3rd tri
usually in first pregnancy
*typically recurs in subsequent pregnancies - begins earlier, lasts longer *
How is PG managed?
- pre-blistering stage: emollients, high-potency topical steroids, PO steroid (prednisone)
- blisters: PO prednisone to reduce pruritus and new blister formation; PO 1st gen antihistamine in 1st tri
- eruptions resolve w/in 4wks PP*
- urticaria may last up to 14wks PP*
How should tx w/ prednisone be managed in PG?
- start at 0.5-1mg/kg/day
- titrate up
- taper w/ relief (about 2wks)
- remain on low dose until just prior to EDD
- increase dose around EDD d/t increased risk of flares
What are risk factors for PG?
- Causasian
- multiparity
- PO contraception can cause flares
What are risks associated with PG?
- no long-term morbidity or mortality
- increased risk of LBW
- prematurity
- IgG crosses placenta –> 10% newborns born w/ lesions; fade w/in a few weeks
What are defining characteristics of intrahepatic cholestasis of pregnancy (ICP)?
- intense, generalized pruritus
- starts on soles and palms –> spreads to arms, shins, abdomen
- pruritus worse at night
- no rash or lesions*
secondary:
- skin infection
- jaundice
What are risk factors for ICP?
- twin pregnancies
- hx ICP
How is ICP dx’ed?
dx of exclusion
- bile acids ~47mcmol/L (normal = 6.6-11)
- increased ALT
- vitamin K deficiency and coagulopathy in severe cases
How is ICP treated?
- emollient
- anti-pruretic topical
- evening primrose oil
- antihistamine to help w/ sleep
- off-label ursodeoxycholic acid (Ursodiol) 13-15mg/kg/day single dose or divided 2-3x/day
What are risks associated w/ ICP?
no long-term complications for gestational carrier
SEVERE complications for fetus d/t build up of toxic bile acids in fetus
- prematurity
- fetal distress
- fetal demise, usually >36wks GA
- stillbirth
- sudden fetal death (w/in hrs)
How is ICP managed?
- NSTs at 34-35wks
- uterine artery doppler studies
- BPP
- deliver at 37-39wks
What txs should be avoided in acne management?
- isotreninoin
- tazarotene
- sprinolactone
What txs can be used to manage acne?
- discuss w/ provider*
- topical abx (e.g. clindamycin)
- PO abx (e.g. cefadroxil for severe acne)
- azelaic acid
- benzoyl peroxide (small amounts)
- laser therapy
- salicyclic acid (limited)
How should fungal infections be treated?
- topical imidazole (miconazole) for 7 days
- NO! PO -azole –> birth defects, miscarriage
