Dermatology Flashcards
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
- Incidence 1:200
- Pathophysiology
-Unknown. Possible due to skin stretching - Risk factors
-Greater maternal weight gain, increased birth weight, primigravida, multiples - Timing of onset - third trimester / postpartum
- Presentation - severe pruritis, urticarial papules and plaques.
- Distrubution, abdomin, back, buttocks and proximal limbs. Spares umbillicus and breasts. Along striae
- Effect on fetus - none
- Management
-Resurrance
-Smoothing balms and emolliants.
-1% topical steriods
-Sedating antihistamines
-Systemic steriods if overwhelming pruritis - Outcome
-Doesn’t usually recur in subsequent pregnancies
-Rapid resolution postpartum
-Self resolving 4-6 weeks
2
Q
Discuss pemphigoid gestationis
-Incidence
-Pathophysiology
-Risk factors
-Timing of onset
-Presentation
-Diagnosis
-Distribution
-Effect on fetus
-Management
-Outcome
A
- Incidence 1-10:50 000
- Pathophysiology
-Autoimmune disorder specific to pregnancy
-Circulating IgG antibodies against hemidesomsomal protiens BP 180 and BP 230 on basement membrane - Risk factors
-Bulous pemphigoid
-T1DM
-Graves
-Vitiligo
-HLA DR3 and HLA DR4 antibodies - Timing of onset
-Usually 3rd trimest but can be second. Onset earlier in subsequent pregnancies - Presentation
-Intense pruitis, uricrial erythematous plaques and papules. Become vesicles and bullae after 2 weeks - Diagnosis
-Clinical presentation
-Biopsy - eosinophillic and lymphocytic infiltrate
-Direct immunoflorescence - C3 compliment deposition at basement membrane
-Indirect immunofluorescence - Antibodies in maternal serum - Distribution
-Starts from umbillicus. Spreads outwards towards torso and limbs. - Effects on fetus
-LBW, Preterm birth, SB
-Simillar transient bullous eruption in 10% of babies - 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 - 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
3
Q
Discuss atopic eruption of pregnancy (AEP)
-Incidence
-Pathophysiology
-Risk factors
-Timing of onset
-Presentation
-Distribution
-Diagnosis
-Effect on fetus
-Management
-Outcome
A
- Incidence 1:300
- Pathophysiology
-Assoicated with atopy. Th 2 mediated
-Three types: Eczema, prurigo pf pregnancy, pruritic folliculitis of pregnancy - Risk factors
-Multiparity - Timing of onset
-75% in first and second trimester - Presentation
-Diffuse eczematous changes in flexure areas, Erythematous excoriated brown or red nodules, follicular papules - Distribution
-extensor surfaces, flexure areas, abdo, back, limbs - Diagnosis - clinical
- Effect on fetus - None
- Management
-Topical steriods 1%
-Antihistamines
-Topical benzoyl peroxide to pustular lesions - Outcome
-Improves after delivery
-Pustules may persist for several months PP
-May recur in subsequent pregnancies
4
Q
Discuss melasma pigmentation in pregnancy
1. Distribution
2. Incidence
3. Pathophysiology
4. Resolution
5. Management
A
- Distribution
-focal hyperpigmentation affecting sun exposed areas - malar region, forehead and upper lip - Incidence - 70%
- Pathophysiology
-Increased melanocytes from melanocyte stimulating hormone from placenta - Resolution - 1yr Postpartum
- Management - hydroyquine, topical steriods, retinoid acid, chemical peels, laser
5
Q
Discuss vascular changes in pregnancy
-Types (4)
-Incidence of each type
-Presentation of each type
-Management of each type
A
- Spider naevi
-Affects 2/3rds of caucasians
-Affects face, neck, arms and chest
-Regress 3months PP. 25% persist - Varicose veins
-Affects saphenous and vulval veins, haemarroids.
-Manage with supportive measures - leg elevation, compression stockings, exercise, sleping on side - Palmar erythema
-Affects 70% of pregnancies
-Regress 1 week post delivery - 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
6
Q
Discuss eczema in pregnancy
-Incidence (2)
-Impact of pregnancy on eczema
-Treatment
A
- Incidence
-Most common rash in pregnancy (50%)
-20% of women will have an exaccerbation in pregnancy - Impact of pregnancy on eczema
-Increase in Th 2 mediated response in pregnancy so eczema worsens - Treatment
-topical emollients and steriod cream
7
Q
Discuss psoriasis in pregnancy
-Impact of pregnancy on psoriasis
-Treatment (3)
A
- 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 - Treatment
-emolliants and mild topical steriods
-UV light
-Ciclosporin/anti TNF alpha
-Methotrexate / hydroxyurea / mycophenalate are contraindicated in pregnancy
8
Q
Discuss impetigo herpetiformis
-Defintion
-Presentation
-Impact to fetus
-Management
-Outcome
A
- Defintion
-A severe form of pustular psoriasis of pregnancy - Presentation
-Typically in flexures and groin
-Sterile pustules which become crusted
-Not pruritic
-Fever, neutrophillia and hypocalcemia - Impact on fetus
-IUGR, Still birth, PTD, LBW - Management
-Fetal growth monitoring
-Systemic corticosteriods
-Correct hypocalcemia
-Consider ciclosporin or infliximab
-Consider delivery - Outcomes
-High recurrence rates in subsequent pregnancy
-Resolves rapidly PP
