Dermatology Flashcards

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1
Q

Discuss polymorphic eruption of pregnancy (PEP) was PUPPS
-Incidence
-Pathophysiology
-Risk factors
-Timing of onset
-Presentation
-Distribution
-Effect on fetus
-Management
-Outcome

A
  1. Incidence 1:200
  2. Pathophysiology
    -Unknown. Possible due to skin stretching
  3. Risk factors
    -Greater maternal weight gain, increased birth weight, primigravida, multiples
  4. Timing of onset - third trimester / postpartum
  5. Presentation - severe pruritis, urticarial papules and plaques.
  6. Distrubution, abdomin, back, buttocks and proximal limbs. Spares umbillicus and breasts. Along striae
  7. Effect on fetus - none
  8. Management
    -Resurrance
    -Smoothing balms and emolliants.
    -1% topical steriods
    -Sedating antihistamines
    -Systemic steriods if overwhelming pruritis
  9. Outcome
    -Doesn’t usually recur in subsequent pregnancies
    -Rapid resolution postpartum
    -Self resolving 4-6 weeks
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2
Q

Discuss pemphigoid gestationis
-Incidence
-Pathophysiology
-Risk factors
-Timing of onset
-Presentation
-Diagnosis
-Distribution
-Effect on fetus
-Management
-Outcome

A
  1. Incidence 1-10:50 000
  2. Pathophysiology
    -Autoimmune disorder specific to pregnancy
    -Circulating IgG antibodies against hemidesomsomal protiens BP 180 and BP 230 on basement membrane
  3. Risk factors
    -Bulous pemphigoid
    -T1DM
    -Graves
    -Vitiligo
    -HLA DR3 and HLA DR4 antibodies
  4. Timing of onset
    -Usually 3rd trimest but can be second. Onset earlier in subsequent pregnancies
  5. Presentation
    -Intense pruitis, uricrial erythematous plaques and papules. Become vesicles and bullae after 2 weeks
  6. Diagnosis
    -Clinical presentation
    -Biopsy - eosinophillic and lymphocytic infiltrate
    -Direct immunoflorescence - C3 compliment deposition at basement membrane
    -Indirect immunofluorescence - Antibodies in maternal serum
  7. Distribution
    -Starts from umbillicus. Spreads outwards towards torso and limbs.
  8. Effects on fetus
    -LBW, Preterm birth, SB
    -Simillar transient bullous eruption in 10% of babies
  9. Management
    -Potent steriods -mometasone / clobetasone
    -Cooling/ soothing balms and emolliants
    -Systemic steriod use not uncommon
    -Sedative antihistamines
    -Fetal GS
    -Screen for drug induced GDM if prolonged steriod use
    -Hydrocortisone may be required in labour
  10. Outcome
    -Recurrence risk in next pregnancy high
    -May improve in late third trimester
    -Can have flares PP
    -Flares triggers by OCP in first 5-6months PP and menstruation
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3
Q

Discuss atopic eruption of pregnancy (AEP)
-Incidence
-Pathophysiology
-Risk factors
-Timing of onset
-Presentation
-Distribution
-Diagnosis
-Effect on fetus
-Management
-Outcome

A
  1. Incidence 1:300
  2. Pathophysiology
    -Assoicated with atopy. Th 2 mediated
    -Three types: Eczema, prurigo pf pregnancy, pruritic folliculitis of pregnancy
  3. Risk factors
    -Multiparity
  4. Timing of onset
    -75% in first and second trimester
  5. Presentation
    -Diffuse eczematous changes in flexure areas, Erythematous excoriated brown or red nodules, follicular papules
  6. Distribution
    -extensor surfaces, flexure areas, abdo, back, limbs
  7. Diagnosis - clinical
  8. Effect on fetus - None
  9. Management
    -Topical steriods 1%
    -Antihistamines
    -Topical benzoyl peroxide to pustular lesions
  10. Outcome
    -Improves after delivery
    -Pustules may persist for several months PP
    -May recur in subsequent pregnancies
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4
Q

Discuss melasma pigmentation in pregnancy
1. Distribution
2. Incidence
3. Pathophysiology
4. Resolution
5. Management

A
  1. Distribution
    -focal hyperpigmentation affecting sun exposed areas - malar region, forehead and upper lip
  2. Incidence - 70%
  3. Pathophysiology
    -Increased melanocytes from melanocyte stimulating hormone from placenta
  4. Resolution - 1yr Postpartum
  5. Management - hydroyquine, topical steriods, retinoid acid, chemical peels, laser
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5
Q

Discuss vascular changes in pregnancy
-Types (4)
-Incidence of each type
-Presentation of each type
-Management of each type

A
  1. Spider naevi
    -Affects 2/3rds of caucasians
    -Affects face, neck, arms and chest
    -Regress 3months PP. 25% persist
  2. Varicose veins
    -Affects saphenous and vulval veins, haemarroids.
    -Manage with supportive measures - leg elevation, compression stockings, exercise, sleping on side
  3. Palmar erythema
    -Affects 70% of pregnancies
    -Regress 1 week post delivery
  4. Pyogenic granuloma
    -Presents as exophytic papules made of granulation tissue. Often on mandibule, maxilla, fingers
    -Due to increased growth factor in pregnancy
    -Partial resolution PP. Can excise esp suspect melanoma
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6
Q

Discuss eczema in pregnancy
-Incidence (2)
-Impact of pregnancy on eczema
-Treatment

A
  1. Incidence
    -Most common rash in pregnancy (50%)
    -20% of women will have an exaccerbation in pregnancy
  2. Impact of pregnancy on eczema
    -Increase in Th 2 mediated response in pregnancy so eczema worsens
  3. Treatment
    -topical emollients and steriod cream
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7
Q

Discuss psoriasis in pregnancy
-Impact of pregnancy on psoriasis
-Treatment (3)

A
  1. Impact of pregnancy on psoriasis
    -Decreased Th 1 mediated response in pregnancy so psoriasis improves.
    -10-20% of women with psoriasis can experience a deterioration
  2. Treatment
    -emolliants and mild topical steriods
    -UV light
    -Ciclosporin/anti TNF alpha
    -Methotrexate / hydroxyurea / mycophenalate are contraindicated in pregnancy
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8
Q

Discuss impetigo herpetiformis
-Defintion
-Presentation
-Impact to fetus
-Management
-Outcome

A
  1. Defintion
    -A severe form of pustular psoriasis of pregnancy
  2. Presentation
    -Typically in flexures and groin
    -Sterile pustules which become crusted
    -Not pruritic
    -Fever, neutrophillia and hypocalcemia
  3. Impact on fetus
    -IUGR, Still birth, PTD, LBW
  4. Management
    -Fetal growth monitoring
    -Systemic corticosteriods
    -Correct hypocalcemia
    -Consider ciclosporin or infliximab
    -Consider delivery
  5. Outcomes
    -High recurrence rates in subsequent pregnancy
    -Resolves rapidly PP
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