Dermatoses in Pregnancy

Question 1

What are the dermatoses in pregnancy?

Answer 1

1. Pruritic urticarial papules and plaques of pregnancy (PUPPP)
2. Pemphigoid gestationis (PG)
3. Atopic eruption of pregnancy (AEP)
4. Intrahepatic cholestasis of pregnancy (ICP)

Question 2

General pruritus affects what % of pregnant women?

Answer 2

20%

Question 3

What is this?

Answer 3

Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP).

Question 4

What is the most common pregnancy-specific dermatoses?

What is the most common dermatosis in pregnancy?

Answer 4

Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP).

Atopic Eruption of pregnancy (AEP)

Question 5

What is Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP) sometimes known as?

Answer 5

PEP (Polymorphic eruption of pregnancy)

Question 6

When does PUPP/PEP occur?

Answer 6

Later part of the 3rd trimester or immmediately after deliver.

Question 7

What pregnant women usually get it?

Answer 7

Primiparous or in multiple pregnancies.

Question 8

How can you tell that it is PUPP/PEP?

Answer 8

There is peri-umbilical sparing.

Question 9

What is the treatment for PUPP/PEP?

Answer 9

• Topical steroids
• Oral anti-histamines

Question 10

How long does it take for PUPP/PEP to resolve with treatment?

Answer 10

It usually occurs 7-10 days after delivery.

Question 11

In PEP/PUPP, is there any risk to the fetus?

Answer 11

No

Question 12

What is this?

Why is it important to diagnose it?

Answer 12

Pemphigoid gestationis (PG)

• Increased risk of low birth weight, pre-term birth etc.​

Question 13

What was pemphigoid gestationis (PG) previously known as?

Answer 13

Herpes Gestationis

Question 14

What are the clinical features of Pemphigoid Gestationis (PG)?

Answer 14

• Late pregnancy & time of delivery.
• itchy urticarial lesion on the trunk.
• Includes peri-umbilical area.
• Rapid progression (unlike PUPP)
• Tense Bullae.
• Usually recurrs and worsens in subsequent pregnancies.

Question 15

What is the treatment for Pemphigoid Gestationis (PG)?

Answer 15

Systemic corticosteroids 0.5mg per kg per day.

Question 16

If doubt of the diagnosis for Pemphigoid Gestationis (PG), what should you do?

What would the investigation show?

Answer 16

Perilesional Punch biopsy for histology and direct IMF.

• Histology - subepidermal bulla with perivascular infiltrate and eosinophils.
• IMF - linear C3 +/- IgG bands along BMZ of peri-lesional skin.

Question 17

Does Pemphigoid Gestationis (PG) recurr?

Answer 17

Yes it usually recurrs and worsens with each pregnancy.

It can also occur with menstruation and with COCP use.

Question 18

What is this?

Answer 18

Atopic eruption of pregnancy (AEP)

Question 19

How do you diagnose atopic eruption of pregnancy (AEP)?

Answer 19

• Mostly clinically
• Direct and indirect IMF - are negative
• Bloods - elevated IgE and hyperesonsinophilia are found in 20-70% of cases.

Question 20

What is the treatment for Atopic Eruption of the Skin (AES )?

Answer 20

• Topical steroids
• Emollients

Question 21

What is Intrahepatic cholestasis of pregnancy (ICP)?

Answer 21

• Intrahepatic cholestasis of pregnancy is a rare liver condition which causes an itchy skin.
• There is no rash but the skin may show scratch marks (excoriations) or become yellow (jaundiced).
• This condition typically develops late in pregnancy.
• Resolves within days after the baby is born.

Question 22

Desribe the algorithm for itch in pregnancy

Answer 22