Dermatoses of Pregnancy Flashcards
What is the autoantibody in pemphigus gestationis?
IgG against Bpag2 or bullous pemphigoid antigen 180
What are the most common physiologic cutaneous changes that occur in pregnancy?
LInea nigra, melasma, telogen effluvium, striae gravidarum, and palmar erythema
When does pemphigoid gestationis generally occur?
2nd to 3rd trimester or immediately post-partum
What is the clinical presentation of pemphigoid gestationis?
Pruritic papules/plaques that lead to blisters and bullae. These tend to be concentrated on the trunk and involve the umbilicus
What is the risk of recurrence of pemphigoid gestationis with future pregnancies?
This does tend to recur with future pregnancies
What is the treatment of pemphigoid gestationis?
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
How long can pemphigoid gestationis last after delivery?
it can persist for weeks to months after delivery for it to completely resolve
Does pemphigoid gestationis carry any risk to the fetus?
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
What HLA subtypes are associated with pemphigoid gestationis?
HLA-DR3 and HLA-DR4
When does polymorphic eruption of pregnancy tend to occur?
Third trimester or just after delivery
What is the clinical presentation of polymorphic eruption of pregnancy?
Urticarial, pruritic papules/plaques with prefer striae dispense (spare the umbilicus unlike pemphigoid gestationis)
Usually spares the face and the exremitites
What are the chances of recurrence with future pregnancies in polymorphic eruption of pregnancy?
Tends not to recur with future pregnancies (most common in primigravid)
What is the course of polymorphic eruption of pregnancy?
Tends to resolve over about 4 weeks. Topical CS and antihistamines can help
Is there any risk of harm to the fetus in polymorphic eruption of pregnancy?
NO
What increases the risk of polymorphic eruption of pregnancy?
Primiparous women and multiple-gestation pregnancies
When does intrahepatic cholestasis of pregnancy tend to occur?
Third trimester
What is the clinical presentation of intrahepatic cholestasis of pregnancy?
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
What is the treatment for intrahepatic cholestasis of pregnancy?
Ursodeoxycholic acid
Important to treat as levels can affect pregnancy
Can intrahepatic cholestasis of pregnancy recurr with future pregnancies?
Yes, tends to recur and can flare with OCP’s
What is the significance of the steatorrhea that can happen in intrahepatic cholestasis of pregnancy?
This can reduce vitamin K levels and increase the risk of hemorrhage in the baby
Is there any risk to the fetus in intrahepatic cholestasis of pregnancy?
Yes, increased risk of premature birth, intrapartum fetal distress, and stillbirth
What lab does the risk of fetal injury in intrahepatic cholestasis of pregnancy correlate with?
Levels of bile acid >40umol/L
What is the product that builds up and why does it build up in intrahepatic cholestasis of pregnancy?
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!
What lab abnormalities can be seen in intrahepatic cholestasis of pregnancy?
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
When does atopic eruption of pregnancy (prurigo of pregnancy) tend to occur?
Usually occurs in the first or second trimester
What is the presentation of atopic eruption of pregnancy (prurigo of pregnancy)?
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)
What are the treatments for atopic eruption of pregnancy (prurigo of pregnancy)?
Topical CS, emolients, antihistamines, UVB for sx control
What is the risk of atopic eruption of pregnancy (prurigo of pregnancy) in future pregnancies?
It does tend to recur with future pregnancies
What are the risks to the fetus in atopic eruption of pregnancy (prurigo of pregnancy)?
None
What lab abnormality can be seen in atopic eruption of pregnancy (prurigo of pregnancy) and how common is this condition?
IgE can be elevated and this is a common condition, the most common pruritic disorder in pregancy
When does impetigo herpetiforms tend to occur?
Usually the third trimester
What is the clinical presentation of impetigo herpetiforms?
Generalized pustular psoriasis starting in flexures (groin mostly)
What is the treatment of impetigo herpetiforms?
Supportive, prednisone
Resolves with delivery
What is the risk of recurrence in future pregnancies with impetigo herpetiforms?
It does tend to recur and can flare with OCP’s
What are the risks to the fetus with impetigo herpetiforms?
Placental insufficiency, stillbirth, neonatal death in bad disease
What lab abnormalities can impetigo herpetiforms be associated with?
Hypocalcemia and decreased vitamin D
Mom can have cardiac/renal failure
