Dermatoses in pregnancy Flashcards
List 3 types of rash in pregnancy
Polymorphic eruption of pregnancy (used to be called PUPs)
Pemphigoid gestationis
atopic eruption of pregnancy
What is the incidence of PUPPS?
1:200
What is the incidence of pemphigoid gestationis?
1:10-50,000
What is the incidence of atopic eruption of pregnancy?
1:300
What is the pathophysiology of PUPPS?
- not known
- stretching of skin resulting in damage to connective tissue
- associated with obesity, multiple pregnancy, primiparous
What is the pathophysiology of pemphigoid gestationis?
- 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
What is the pathophysiology of atopic eruption of pregnancy?
- association with atopy
- TH2 mediated
- associated with multiparity
- 3 types - eczema, prurigo of pregnancy, pruritic folliculitis of pregnancy
What is the timing of onset of PUPPs rash?
Third trimester
What is the timing of onset of Pemphigoid gestationis?
- anytime but more commonly 3rd trimester
- earlier in each subsequent pregnancy
What is the timing of onset of atopic eruption of pregnancy?
earlier onset
75% in 1st and 2nd trimester
What is the distribution of the PUPPS rash?
abdominal and proximal limbs
umbilical sparing
What is the distribution of pemphigoid gestationis rash?
Peri-umbilical and abdominal
spreads peripherally to limbs, palms and soles
does not affect face or mucous membranes
What is the distribution of atopic eruption of pregnancy rash?
typical atopic sites - extensor surfaces/creases
abdo/back/chest
How would the rash of PUPPs be described
Urticarial papules and plaques
halo around the papules/plaques
severe pruritis
How would the rash of pemphigoid gestationis be described?
pruritic, erythematous plaques
target lesions
after 2/52 vesicles and tense bullae may form
How would the rash of atopic eruption of pregnancy be described?
diffuse eczematous changes to face, neck, flexion areas
eczematous brown nodules or papules
How would the rash of atopic eruption of pregnancy be described?
diffuse eczematous changes to face, neck, flexion areas
eczematous brown nodules or papules
How would the rash of atopic eruption of pregnancy be described?
diffuse eczematous changes to face, neck, flexion areas
eczematous brown nodules or papules
follicular papules or pustule eruptions
How long does PUPPs take to resolve?
- self limiting
- 4-6 weeks
- does not usually recur
How long does Pemphigoid gestationis take to resolve?
- 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
How long does atopic eruption of pregnancy take to resolve?
pruritis improves after delivery
papules may persist for several months post partum
may recur in subsequent pregnancies
How long does atopic eruption of pregnancy take to resolve?
pruritis improves after delivery
papules may persist for several months post partum
may recur in subsequent pregnancies
Are there any fetal effects associated with PUPPs?
No
Are there any fetal effects with pemphigoid gestationis?
- low brith weight
- pre term
- stillbirth - 30%
- similar transient bullous eruption in 10% of babies
Are there any fetal effects associated with atopic eruption in pregnancy?
no
How is diagnosis of PUPPs made?
Clinical diagnosis
can biopsy to rule out other conditions
negative immunoflourescence distinguishes PUPPs from pemphigoid
How is the diagnosis of pemphigoid gestationis made?
skin biopsy/histology
direct immunofluorescence - c3 complement deposition at basement membrane
indirect immunofluorescence - antibodies in maternal serum
How is diagnosis of atopic eruption of pregnancy made?
clinical
if folliculitis obtain culture to rule out bacterial or candida infection
How do you manage PUPPs?
reassure cool soothing baths emollients 1% menthol in aqueous cream topical steroids sedating anti-histamines consider systemic steroids if severe and intractable
How do you manage pemphigoid gestationis
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
How do you manage atopic eruption of pregnancy?
Topical steroids 1% hydrocortisone
topical benzoyl peroxide to pustular lesions
anti-histamines PRN
