DERMATOLOGIC DISORDERS IN OBSTETRICS Flashcards
elevated by 8 weeks AOG
MSH
Develops in 90% of pregnant women
Pigmentation
Prevention of pigmentation
avoid excessive sun exposure
- pemphigoid gestations
- pruritic urticarial papules and plaques of pregnancy
INTRAHEPATIC CHOLESTASIS
- Pruritus gravidarum
- 0.5% incidence
- associated with abnormally elevated serum levels of Bile acids
- Rash precedes pruritus
Intrahepatic Cholestasis
- Autoimmune bullous disease
- Papules and plaques x 2 weeks
- Lesions: periumbilical
- subepidermal edema with perivascular infiltrates of lymphocytes, histocytes, and eosinophils
Pemphigoid Gestationis
-treatment of Pemphigoid Gestationis
- Skin biopsy, serum antibody assay
- topical High potency CS, oral AH
- Oral Prednisone 0.5 – 1 mg/kg – tapered
- Plasma pharesis, IVIG
- Benign effect on pregnancy
- Intensely pruritic 1-2 mm erythematous papule that coalsece to form urticarial plaques
- 97% abdomen and thighs
- White women, nulliparous
- carrying a male offspring
- most cases resolve after delivery, or some 3-4 weeks post partum
Pruritic urticarial papules and plaques (PUPPP)
TX of Pruritic urticarial papules and plaques
oral AH, emollients, corticosteroids
-Encompasses eczema of pregnancy, prurigo of pregnancy and pruritic folliculitis of pregnancy
-2/3 Widespread eczematous changes,
1/3 papular lesions
-Eczema in Pregnancy
-Prurigo Gestationis
-Pruritic folliculitis of pregnancy
-ONSET: second trimester of pregnancy
ATOPIC ERUPTION of Pregnancy (AEP)
TX of Atopic Eruption Pregnancy
-Low to moderate potency topical corticosteroids, antihistamine
- no primary lesions , secondary excoriations from scratching
- increased perinatal morbidity
Cholestasis of pregnancy
-treatment of Cholestasis of pregnancy
-antipruritics, cholestyramine, ursodeoxycholic acid
- common
- dry, red scaly patches on extremity flexures, neck, face
Eczema of Pregnancy
-common
1-5 mm pruritic red papules on extensor surfaces, trunk
Prurigo of Pregnancy
- rare
- small red papules, sterile pustules on trunk
Pruritic folliculitis of Pregnancy
- dermatologic conditions not specific to pregnancy
- Topical retinoids : not safe in pregnancy esp during first trimester
ACNE VULGARIS
TX of Acne Vulgaris
topical erythromycin, clindamycin
- dermatologic conditions not specific to pregnancy
- no risk of adverse pregnancy outcome
PSORIASIS
-Tx of Psoriasis
emollients
systemic sx
General pustular psoriasis of pregnancy
Treatment of General pustular psoriasis of pregnancy
- prednisone, cyclosporine, infliximab, topical steroids
- Secondary infection: antibiotic IV
- resolves quickly during puerperium
- dermatologic conditions not specific to pregnancy
- Inflammation of subcutaneous fat
- 1-6cm, red warm, tender nodules on the extensor surface of legs
- Symptoms resolve in 1-6 weeks without scarring
Erythema Nodosum
- dermatologic conditions not specific to pregnancy
- Frequently seen in pregnancy
- Lobular capillary hemangioma forming on the mouth and hand
- for active bleeding: monsel paste
- Resolve within months postpartum
Pyogenic Granuloma
- dermatologic conditions not specific to pregnancy
- Neurofibroma, café au lait spots, axillary and inguinal freckling benign nodules of the iris, optic nerve glioma,
- May increase in size and no. during pregnancy
Neurofibromatosis
higher incidence of pre-eclampsia and Preterm delivery
Type 1 Neurofibromatosis
