Dermatology in pregnancy

Question 1

Name some normal physiological skin manifestations occurring in pregnancy

Answer 1

• melasma
• striae
• Eczema flare up

Question 2

How does obstetric cholestasis present?

Answer 2

During pregnancy 
Pruritus - caused by a build up of bile 
Jaundice in some cases 
No long term implications but do require intense monitoring - worry about HELLP syndrome 
Affects 1 in 7000 women

Question 3

What is an Atopic eruption during pregnancy?

Answer 3

There is a Th1 to Th2 shift in pregnancy - prevent rejection of fetus (IgG, IgA and IgM are all reduced but Th2 and IgE compensate and dominate)

This can make Th2/IgE mediated autoimmune/hypersensitivity reactions worse eg. Eczema and other Atopic conditions such as asthma and hayfever (type 1 hypersensitivity)

Question 4

What is a polymorphic eruption in pregnancy?

Answer 4

Pruritic++ erythmatous papules found on existing striae, begin AROUND umbilicus and spreads over trunk and limbs

Throught to be an immune response to skin damage due to stretch - tends to occur in 3rd trimester and more common in twin pregnancies

Question 5

What is pemphigoid gestationis and how dies it present differently to PEP?

Answer 5

NOT umbilical sparing (unlike PEP)
Autoimmune skin reaction occurring in pregnancy
PG factor (IgG) positive
Causes vesicular/blistering discoid erythmatous rash - Pruritic
Less confluent that PEP

Question 6

What risks are associated with Pemphigoid gestationis?

Answer 6

IgG - so can cross the placenta - transient blistering of newborn (which resolves spontaneously)
Infection of blisters
Premature delivery

Symptoms usually resolve in mother soon after birth but she may even need treatment with DMARDS during pregnancy if severe enough

Question 7

What is one of the most common skin manifestations of pregnancy?

Answer 7

Pruritus (maybe due to IgE tendency of pregnant women??)