Preganancy-related rashes

Question 1

What is Polymorphic Eruption of Pregnancy (PEP)?

Answer 1

Common intensely pruritic skin lesions occurring in the last trimester of pregnancy or immediate postpartum period

Also known as Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP)

Question 2

In which trimester does Polymorphic Eruption of Pregnancy primarily occur?

Answer 2

Last trimester of pregnancy or immediate postpartum period

Question 3

Which pregnancies are more likely to experience Polymorphic Eruption of Pregnancy?

Answer 3

Primarily first pregnancies and multigestational pregnancies

Question 4

Does Polymorphic Eruption of Pregnancy run in families?

Answer 4

No, it doesn’t run in families

Question 5

What factors increase the likelihood of developing Polymorphic Eruption of Pregnancy?

Answer 5

• First pregnancy
• Multigestational pregnancy
• Excessive weight gain

Question 6

Where do the skin lesions of Polymorphic Eruption of Pregnancy typically start?

Answer 6

In striae/stretch marks on the abdomen

Question 7

Which areas are typically spared from Polymorphic Eruption of Pregnancy lesions?

Answer 7

• Head
• Palms and soles
• Genital area
• Umbilicus

Question 8

What are the clinical features of Polymorphic Eruption of Pregnancy?

Answer 8

• Edematous urticarial papules that become plaques
• Non-urticatial erythematous rash
• Small vesicles that leak straw-coloured fluid

Question 9

What colors do the lesions appear on light and dark skin tones?

Answer 9

• Pink on light skin tones
• Dark red-brown on dark skin tones

Question 10

What is the typical duration for Polymorphic Eruption of Pregnancy to resolve?

Answer 10

4-6 weeks

Question 11

What is the management approach for Polymorphic Eruption of Pregnancy?

Answer 11

• Usually self-limiting
• Emollients and bath soap substitutes
• Pregnancy-safe oral antihistamines

Question 12

True or False: Polymorphic Eruption of Pregnancy poses a risk to the fetus or mother.

Answer 12

False

Question 13

What types of oral antihistamines are recommended for Polymorphic Eruption of Pregnancy?

Answer 13

• Loratadine
• Cetirizine

Question 14

What type of rash can develop from the non-urticatial erythematous rash in Polymorphic Eruption of Pregnancy?

Answer 14

Eczema plaques or targetoid lesions

Question 15

Fill in the blank: Polymorphic Eruption of Pregnancy is also known as _______.

Answer 15

Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP)

Question 16

What type of diagnosis is used for Polymorphic Eruption of Pregnancy?

Answer 16

Clinical diagnosis

Question 17

What is Pemphigoid gestationis (PG)?

Answer 17

A rare form of bullous pemphigoid that presents during the third trimester or immediate postpartum period.

Question 18

What is the pathophysiology of Pemphigoid gestationis?

Answer 18

Circulating IgG autoantibodies target the antigens collagen XVII (BP antigen 2, BPAG2) and BPAG1, which are found on hemidesmosomes.

Question 19

What can induce Pemphigoid gestationis?

Answer 19

It can be drug-induced, for example, by sulfur-containing drugs like furosemide, sulfasalazine, and antibiotics like amoxicillin and penicillin.

Question 20

What are the clinical features of Pemphigoid gestationis?

Answer 20

Lesions begin around and inside the umbilicus, then diffuse to the abdomen and extremities, with intense pruritus followed by erythematous urticarial plaques and papules.

Question 21

What are the characteristics of the lesions in Pemphigoid gestationis?

Answer 21

Tense vesicles and bullae with clear fluid, similar to those in bullous pemphigoid.

Question 22

What is the gold standard investigation for Pemphigoid gestationis?

Answer 22

Direct Immunofluorescence (DIF) microscopy, which shows linear IgG and/or linear C3 deposits along the dermoepidermal junction.

Question 23

What other investigations can be done for Pemphigoid gestationis?

Answer 23

An ELISA assay will identify anti-BPAG2 and anti-BPAG1 antibodies, and tissue biopsy histology shows subepidermal bullae with eosinophilic infiltrate.

Question 24

How does Pemphigoid gestationis differ from PEP?

Answer 24

PG has periumbilical involvement and causes bullae, while PEP has no periumbilical involvement and doesn’t cause bullae.

Question 25

What is the management for Pemphigoid gestationis?

Answer 25

Management is important as 10% of cases have a higher risk of prematurity, placental insufficiency, and newborn low birth weight. Treatment includes oral or systemic corticosteroids and oral histamines, but it should regress spontaneously after delivery.

Question 26

What is the recommendation for antenatal monitoring in Pemphigoid gestationis?

Answer 26

Referral to obstetrics for antenatal monitoring is recommended.

Question 27

What is Atopic Eruption of Pregnancy?

Answer 27

Atopic dermatitis presenting or worsening during pregnancy, including prurigo of pregnancy and pruritic folliculitis of pregnancy.

Question 28

What is Prurigo of pregnancy?

Answer 28

A benign non-specific itchy papular rash occurring during pregnancy.

It affects 46% of pregnant women with atopic eruptions.

Question 29

What is Pruritic folliculitis of pregnancy?

Answer 29

A benign non-specific itchiness with papular and pustular follicles.

Question 30

When is Atopic Eruption of Pregnancy more common?

Answer 30

More common during the first trimester than the second trimester, and very rare to present later in pregnancy.

Question 31

Who is more likely to experience Atopic Eruption of Pregnancy?

Answer 31

More common in women with a personal or family history of atopic eczema and other atopic conditions.

Question 32

Can Atopic Eruption of Pregnancy recur?

Answer 32

Yes, it is common to recur in subsequent pregnancies, not just the first.

Question 33

What are the clinical features of Atopic Eruption of Pregnancy?

Answer 33

Eczematous lesions distributed on the abdomen, breasts, and flexural surfaces of extremities, with small erythematous papules and large prurigo nodules.

Question 34

How is Atopic Eruption of Pregnancy diagnosed?

Answer 34

Clinical diagnosis.

Question 35

What is the management for Atopic Eruption of Pregnancy?

Answer 35

Emollients, moderately-potent corticosteroid creams, and sedating antihistamines such as loratadine, fexofenadine, or cetirizine.

Question 36

What is Intrahepatic/Obstetric Cholestasis of Pregnancy?

Answer 36

A liver disorder that occurs during the third trimester of pregnancy, characterised by pruritus due to increased serum bile acids.

Question 37

What is the epidemiology of Intrahepatic/Obstetric Cholestasis of Pregnancy?

Answer 37

Genetic predisposition with higher incidence in native South Americans. Associated with intrapartum foetal distress, prematurity, and stillbirths.

Question 38

What severe complications can occur with Intrahepatic/Obstetric Cholestasis of Pregnancy?

Answer 38

In severe cases, vitamin K deficiency may occur, with an increased risk of haemorrhage.

Question 39

What is the pathophysiology of Intrahepatic/Obstetric Cholestasis of Pregnancy?

Answer 39

Deposition of bile salts in the skin, elevated levels of lysophosphatidic acid (LPA), and a sulfated metabolite of progesterone called PM3S, all of which are pruritogens.

Question 40

What are the clinical features of Intrahepatic/Obstetric Cholestasis of Pregnancy?

Answer 40

Generalised intense pruritus without a rash. Signs of liver disease include jaundice, nausea and vomiting, fatigue, dark urine, pale stool, and right upper quadrant abdominal pain.

Question 41

What investigations are done for Intrahepatic/Obstetric Cholestasis of Pregnancy?

Answer 41

Liver function tests (LFTs) and bile acid measurement tests to rule out other causes of hepatic impairment.

Question 42

What is the management for Intrahepatic/Obstetric Cholestasis of Pregnancy?

Answer 42

Weekly monitoring by obstetrics to ensure serum bile acids and liver function remain normal. Treatment includes sedating oral antihistamines (e.g., promethazine) and emollients.