Dermatoses of Pregnancy

Question 1

What is the autoantibody in pemphigus gestationis?

Answer 1

IgG against Bpag2 or bullous pemphigoid antigen 180

Question 2

What are the most common physiologic cutaneous changes that occur in pregnancy?

Answer 2

LInea nigra, melasma, telogen effluvium, striae gravidarum, and palmar erythema

Question 3

When does pemphigoid gestationis generally occur?

Answer 3

2nd to 3rd trimester or immediately post-partum

Question 4

What is the clinical presentation of pemphigoid gestationis?

Answer 4

Pruritic papules/plaques that lead to blisters and bullae. These tend to be concentrated on the trunk and involve the umbilicus

Question 5

What is the risk of recurrence of pemphigoid gestationis with future pregnancies?

Answer 5

This does tend to recur with future pregnancies

Question 6

What is the treatment of pemphigoid gestationis?

Answer 6

Topical steroids if mild or systemic if severe (taper once lesions resolved)

Will often spontaneously resolve but then flair around time of delivery, with menstruation or with OCP’s

Question 7

How long can pemphigoid gestationis last after delivery?

Answer 7

it can persist for weeks to months after delivery for it to completely resolve

Question 8

Does pemphigoid gestationis carry any risk to the fetus?

Answer 8

Yes, increased risk of prematurity and small for gestational age

The baby can also have mild transient pemphigoid lesions

The relative risk to the fetus is correlated with the degree of cutaneous findings

Question 9

What HLA subtypes are associated with pemphigoid gestationis?

Answer 9

HLA-DR3 and HLA-DR4

Question 10

When does polymorphic eruption of pregnancy tend to occur?

Answer 10

Third trimester or just after delivery

Question 11

What is the clinical presentation of polymorphic eruption of pregnancy?

Answer 11

Urticarial, pruritic papules/plaques with prefer striae dispense (spare the umbilicus unlike pemphigoid gestationis)

Usually spares the face and the exremitites

Question 12

What are the chances of recurrence with future pregnancies in polymorphic eruption of pregnancy?

Answer 12

Tends not to recur with future pregnancies (most common in primigravid)

Question 13

What is the course of polymorphic eruption of pregnancy?

Answer 13

Tends to resolve over about 4 weeks. Topical CS and antihistamines can help

Question 14

Is there any risk of harm to the fetus in polymorphic eruption of pregnancy?

Answer 14

NO

Question 15

What increases the risk of polymorphic eruption of pregnancy?

Answer 15

Primiparous women and multiple-gestation pregnancies

Question 16

When does intrahepatic cholestasis of pregnancy tend to occur?

Answer 16

Third trimester

Question 17

What is the clinical presentation of intrahepatic cholestasis of pregnancy?

Answer 17

Extreme generalized pruritus w/o a primary rash

This tends to be worse at night, severely affects the palms and soles, and excoriation and prurigo nodules can be seen

Question 18

What is the treatment for intrahepatic cholestasis of pregnancy?

Answer 18

Ursodeoxycholic acid

Important to treat as levels can affect pregnancy

Question 19

Can intrahepatic cholestasis of pregnancy recurr with future pregnancies?

Answer 19

Yes, tends to recur and can flare with OCP’s

Question 20

What is the significance of the steatorrhea that can happen in intrahepatic cholestasis of pregnancy?

Answer 20

This can reduce vitamin K levels and increase the risk of hemorrhage in the baby

Question 21

Is there any risk to the fetus in intrahepatic cholestasis of pregnancy?

Answer 21

Yes, increased risk of premature birth, intrapartum fetal distress, and stillbirth

Question 22

What lab does the risk of fetal injury in intrahepatic cholestasis of pregnancy correlate with?

Answer 22

Levels of bile acid >40umol/L

Question 23

What is the product that builds up and why does it build up in intrahepatic cholestasis of pregnancy?

Answer 23

Product are bile acids, and these build up because of decreased excretion

Important Note that these are bile acids and this is the test that is requested, not bilirubin!

Question 25

What lab abnormalities can be seen in intrahepatic cholestasis of pregnancy?

Answer 25

Total bilirubin can be high but usually the value is not significantly high. ALT and AST are considered probably the most sensitive and elevations in these can be seen. There can also be mild elevations in GGT. Alk phos can also be elevated but is expected to be elevated due to production from the placenta. Should check bile acids, these should be elevated but there is no agreement as to the levels for diagnosis

Question 26

When does atopic eruption of pregnancy (prurigo of pregnancy) tend to occur?

Answer 26

Usually occurs in the first or second trimester

Question 27

What is the presentation of atopic eruption of pregnancy (prurigo of pregnancy)?

Answer 27

An eczematous or papular eruption usually in typical sites (flexural surfaces).

Check for hx of atopy as this is common (often w/ hx of AD)

Question 28

What are the treatments for atopic eruption of pregnancy (prurigo of pregnancy)?

Answer 28

Topical CS, emolients, antihistamines, UVB for sx control

Question 29

What is the risk of atopic eruption of pregnancy (prurigo of pregnancy) in future pregnancies?

Answer 29

It does tend to recur with future pregnancies

Question 30

What are the risks to the fetus in atopic eruption of pregnancy (prurigo of pregnancy)?

Answer 30

None

Question 31

What lab abnormality can be seen in atopic eruption of pregnancy (prurigo of pregnancy) and how common is this condition?

Answer 31

IgE can be elevated and this is a common condition, the most common pruritic disorder in pregancy

Question 32

When does impetigo herpetiforms tend to occur?

Answer 32

Usually the third trimester

Question 33

What is the clinical presentation of impetigo herpetiforms?

Answer 33

Generalized pustular psoriasis starting in flexures (groin mostly)

Question 34

What is the treatment of impetigo herpetiforms?

Answer 34

Supportive, prednisone

Resolves with delivery

Question 35

What is the risk of recurrence in future pregnancies with impetigo herpetiforms?

Answer 35

It does tend to recur and can flare with OCP’s

Question 36

What are the risks to the fetus with impetigo herpetiforms?

Answer 36

Placental insufficiency, stillbirth, neonatal death in bad disease

Question 37

What lab abnormalities can impetigo herpetiforms be associated with?

Answer 37

Hypocalcemia and decreased vitamin D

Mom can have cardiac/renal failure