Dermatologic disorders specific to pregnancy Flashcards
1
Q
Describe pigmentation changes in pregnancy and etiology
A
- Hyperpigmentation - mild localized or generalized in up to 90% of people
- most noticeable in the areolae, nipples, genital skin, axillae, and inner thighs
- Melasma (chloasma) - facial hyperpigmentation
- symmetric, poorly demarcated patches are commonly seen on the cheeks (malar pattern) and are often distributed over the entire central face (centrofacial pattern)
- melanin deposition in the epidermis
- typically is exacerbated by exposure to ultraviolet and visible light
- usually resolves postpartum but may recur in subsequent pregnancies or with the use of oral contraceptives
- Uncommon
- Jaundice
- Pseudoacanthotic changes
- Dermal melanocytosis
- Hyperkeratosis of the nipple
- Vulvar melanosis
2
Q
Polymorphic eruption of pregnancy/ Pruritic urticarial papule and placques of pregnancy (PEP/PUPPS)
- Incidence
A
- Common: 0.25 - 1%
- Onset usually 3rd tri
- More common in White people, nullipara, multiple gestation
- Seldom reoccurs
3
Q
Polymorphic eruption of pregnancy/ Pruritic urticarial papule and placques of pregnancy (PEP/PUPPS)
- Signs, symptoms
A
-
INVOLVE STRAIE
- Typically begin in abdominal striae and spare periumbilical area
- Intense pruritus
- Patchy or generalized on abdomen, thighs, arms, buttocks
- Erythematous papules, urticarial papules, plaques
- red bumps or halos
- rarely presents as blisters
- Topical steriods or antihistamine (sedating) at bedtime
- Should resolve postpartum. If not → refer
4
Q
Polymorphic eruption of pregnancy/ Pruritic urticarial papule and placques of pregnancy (PEP/PUPPS)
- Pathophysiology
A
- Unknown patho
- Immunohistologic profile of skin lesions suggests a delayed hypersensitivity reaction to an unknown antigen
- No risk of harm to mother or fetus
5
Q
Atopic eruption of pregnancy (AEP)
Prurigo
- Incidence
A
- aka prurigo gestationis, papular dermatitis
- Uncommon (1 : 300– 1 : 2400)
6
Q
Atopic eruption of pregnancy (AEP)
Prurigo
- Signs, symptoms
A
- Onset late 2nd or 3rd trimester
- Excoriated or crusted pruritic papules
- 1 – 5 mm
- Often grouped
- Localized or generalized
- Usually forearms and trunk
- Antipruritics, topical steroids, oral steroids if severe
7
Q
Atopic eruption of pregnancy (AEP)
Prurigo
- Pathophysiology
A
- Associated with family hx of intrahepatic cholestasis of pregnancy
- Not harmful to pregnancy
8
Q
Atopic eruption of pregnancy (AEP)
Pruritic folliculitis
- Incidence
A
Rare
about 30 cases reported ever
9
Q
Atopic eruption of pregnancy (AEP)
Pruritic folliculitis
- Signs, symptoms
- Pathophysiology
A
- Onset 2nd or 3rd tri
- Pruritic follicular erythematous papules and pustules
- Affect primarily the trunk
- Resolves post pregnancy
- Not associated with risk to fetus, may recur
- Pathophys unknown
- Biopsy shows sterile folliculitis
10
Q
Atopic eruption of pregnancy (AEP)
Atopic dermatitis
- Incidence
- Signs, symptoms
- Pathophysiology
A
- Can be new or exacerbation of previous AD
- Lesions in the flexural surfaces of the extremities
- Occasionally with concomitant lesions on the trunk.
- Less common presentations are palmoplantar pompholyx eczema and follicular and facial eczema.
- Lesions can develop bacterial or viral superinfection
- Eczema herpeticum and disseminated herpetic infection, the latter of which may lead to fetal risk, should be promptly treated with intravenous (IV) acyclovir to minimize maternal and fetal risks
- Not associated with fetal risk
- Tx for gestational exacerbations of AD is primarily symptomatic → moisturizer and low potency to midpotent topical steroid is the first-line treatment.
- Systemic antihistamines can also be used as necessary for relief of pruritus.
- Short course of oral steroids for severe AD. Ultraviolet light B (UVB) is a safe second-line treatment for eczema in pregnancy
11
Q
Intrahepatic cholestasis of pregnancy (ICP)
- Incidence
A
- 0.5 - 1% of pregnancies
- Often appears 2nd & mostly 3rd tri
12
Q
Intrahepatic cholestasis of pregnancy (ICP)
- Signs, symptoms
A
- No rash but might see scratch marks/excoriations, rarely jaundice
- Can get secondary skin infections from scratching
- Intense itching often starts in or just in hands and feet. Can also be abdomen and thighs
- Worse at night
- Order liver panel and bile acids
- Bile acids > 10 mcmol/L is most sensitive/specific indicator
13
Q
Intrahepatic cholestasis of pregnancy (ICP)
- Pathophysiology
A
- High risk for twins
- Often have family hx of ICP, also high recurrence during subsequent pregnancies
- Thought to be increased estrogen → cholestasis(cholesterol)
- Elevated bile acids (often a send out labs)
- Untreated ICP can lead to fetal distress and death
- Urosdial/Actigall
- Consult with MD, will need biweekly NSTs (starting at 34-35 wks) and often delivered early by 36-37 weeks
14
Q
Pemphigoid gestationis/herpes gestationis
- Incidence
A
Rare
(1 in 7,000 - 50,000)
Mostly in White people
15
Q
Pemphigoid gestationis/herpes gestationis
- Signs, symptoms
A
- Extremely pruritic urticarial lesions
- Typically start on abdomen and trunk
- Commonly involve the umbilicus
- Rapidly progress to widespread bullous lesions that may affect the palms and soles
- Rarely face and mucous membranes.
- Tense bullous lesions arise in both inflamed and clinically normal skin and usually heal without scarring.
- Up to 25% of cases can present in the postpartum period, although these may represent recrudescences of previously undiagnosed mild PG
16
Q
Pemphigoid gestationis/herpes gestationis
- Pathophysiology
A
- Autoimmune
- IgG directe to attack a hemidismosome transmembrane glycoprotein (accounts for several blistering skin disorders)
- People with hx of PG have a higher incidence of autoimmune diseases: Graves disease, Hashimoto thyroiditis, pernicious anemia, and autoimmune thrombocytopenia
- Babies at risk for: SGA, PTD
- up to 10% will get skin lesions too
- Oral corticosteriods is tx
17
Q
Compare hallmark findings, maternal/ fetal risks, diagnostic criteria and management options of skin dermatoses and skin manifestations of disease associated with pregnancy
A
- PP - Prurigo of Pregnancy
- PUPP/PEP - Pruritic Urticarial Papules and Plaques of Pregnancy/Polymorphic Eruption of Pregnancy
- PFP - Prutitic Folliculitis of Pregnancy
- PG - Pemphigoid Gestationis
- IH - Impetigo Herpetiformis
- ICP - Intrahepatic Cholestasis of Pregnancy
