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Obstetrics > Dermatoses in pregnancy > Flashcards

Dermatoses in pregnancy Flashcards

1
Q

List 3 types of rash in pregnancy

A

Polymorphic eruption of pregnancy (used to be called PUPs)
Pemphigoid gestationis
atopic eruption of pregnancy

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2
Q

What is the incidence of PUPPS?

A

1:200

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3
Q

What is the incidence of pemphigoid gestationis?

A

1:10-50,000

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4
Q

What is the incidence of atopic eruption of pregnancy?

A

1:300

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5
Q

What is the pathophysiology of PUPPS?

A
  • not known
  • stretching of skin resulting in damage to connective tissue
  • associated with obesity, multiple pregnancy, primiparous
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6
Q

What is the pathophysiology of pemphigoid gestationis?

A
  • autoimmune condition (pregnancy specific)
  • IgG antibodies target basement membrane zone protein BP180
  • associated with; T1DM, graves, rheumatoid arthritis (other AI conditions)
  • HLA-DR3 and HLA-DR4 association
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7
Q

What is the pathophysiology of atopic eruption of pregnancy?

A
  • association with atopy
  • TH2 mediated
  • associated with multiparity
  • 3 types - eczema, prurigo of pregnancy, pruritic folliculitis of pregnancy
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8
Q

What is the timing of onset of PUPPs rash?

A

Third trimester

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9
Q

What is the timing of onset of Pemphigoid gestationis?

A
  • anytime but more commonly 3rd trimester

- earlier in each subsequent pregnancy

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10
Q

What is the timing of onset of atopic eruption of pregnancy?

A

earlier onset

75% in 1st and 2nd trimester

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11
Q

What is the distribution of the PUPPS rash?

A

abdominal and proximal limbs

umbilical sparing

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12
Q

What is the distribution of pemphigoid gestationis rash?

A

Peri-umbilical and abdominal
spreads peripherally to limbs, palms and soles
does not affect face or mucous membranes

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13
Q

What is the distribution of atopic eruption of pregnancy rash?

A

typical atopic sites - extensor surfaces/creases

abdo/back/chest

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14
Q

How would the rash of PUPPs be described

A

Urticarial papules and plaques
halo around the papules/plaques
severe pruritis

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15
Q

How would the rash of pemphigoid gestationis be described?

A

pruritic, erythematous plaques
target lesions
after 2/52 vesicles and tense bullae may form

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16
Q

How would the rash of atopic eruption of pregnancy be described?

A

diffuse eczematous changes to face, neck, flexion areas

eczematous brown nodules or papules

16
Q

How would the rash of atopic eruption of pregnancy be described?

A

diffuse eczematous changes to face, neck, flexion areas

eczematous brown nodules or papules

16
Q

How would the rash of atopic eruption of pregnancy be described?

A

diffuse eczematous changes to face, neck, flexion areas
eczematous brown nodules or papules
follicular papules or pustule eruptions

17
Q

How long does PUPPs take to resolve?

A
  • self limiting
  • 4-6 weeks
  • does not usually recur
18
Q

How long does Pemphigoid gestationis take to resolve?

A
  • may improve nearing end of pregnancy
  • flares can occur postpartum
  • may develop into bullous pemphigoid
  • may recur in subsequent pregnancies or with use of OCP
19
Q

How long does atopic eruption of pregnancy take to resolve?

A

pruritis improves after delivery
papules may persist for several months post partum
may recur in subsequent pregnancies

19
Q

How long does atopic eruption of pregnancy take to resolve?

A

pruritis improves after delivery
papules may persist for several months post partum
may recur in subsequent pregnancies

20
Q

Are there any fetal effects associated with PUPPs?

A

No

21
Q

Are there any fetal effects with pemphigoid gestationis?

A
  • low brith weight
  • pre term
  • stillbirth - 30%
  • similar transient bullous eruption in 10% of babies
22
Q

Are there any fetal effects associated with atopic eruption in pregnancy?

A

no

23
Q

How is diagnosis of PUPPs made?

A

Clinical diagnosis
can biopsy to rule out other conditions
negative immunoflourescence distinguishes PUPPs from pemphigoid

24
Q

How is the diagnosis of pemphigoid gestationis made?

A

skin biopsy/histology
direct immunofluorescence - c3 complement deposition at basement membrane
indirect immunofluorescence - antibodies in maternal serum

25
Q

How is diagnosis of atopic eruption of pregnancy made?

A

clinical

if folliculitis obtain culture to rule out bacterial or candida infection

26
Q

How do you manage PUPPs?

A 
reassure
cool soothing baths
emollients
1% menthol in aqueous cream
topical steroids
sedating anti-histamines
consider systemic steroids if severe and intractable
27
Q

How do you manage pemphigoid gestationis

A

Simple measures - cool soothing baths, emollients
topical steroids 0.05% clobetasone (lower potency than clobetasol)
sedative anti-histamines
systemic steroids
sometimes azathioprine or cyclosporine is required

28
Q

How do you manage atopic eruption of pregnancy?

A

Topical steroids 1% hydrocortisone
topical benzoyl peroxide to pustular lesions
anti-histamines PRN

Obstetrics (28 decks)

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