Pregnancy-Related Rashes

Question 1

Polymorphic Eruption of Pregnancy

Answer 1

Pruritic and urticarial papules and plaques of pregnancy

Question 2

When does polymorphic eruption of pregnancy normally occur

Answer 2

During the third trimester

Question 3

Presentation of polymorphic eruption of pregnancy

Answer 3

Begins on the abdomen
Particularly associated with stretch marks (striae).

It is characterised by:

• Urticarial papules (raised itchy lumps)
• Wheals (raised itchy areas of skin)
• Plaques (larger inflamed areas of skin)

Question 4

When does polymorphic eruption of pregnancy get better

Answer 4

Gets better towards the end of pregnancy and after delivery

Question 5

Management of polymorphic eruption of pregnancy

Answer 5

Symptomatic relief with:

• Topical emollients
• Topical steroids
• Oral antihistamines - chlorphenamine for sleep
• Oral steroids may be used in severe cases

Question 6

Atopic Eruption of Pregnancy

Answer 6

Eczema that flares up during pregnancy in woman with existing eczema or never having eczema previously

Question 7

When does atopic eruption of pregnancy occur

Answer 7

First and second trimester

Question 8

Types of atopic eruption of pregnancy

Answer 8

E-type (eczema-type) with eczematous, inflamed, red and itchy skin, typically affecting the insides of the elbows, back of knees, neck, face and chest.

P-type (prurigo-type): with intensely itchy papules typically affecting the abdomen, back and limbs.

Question 9

Management of atopic eruption of pregnancy

Answer 9

Symptomatic relief with:

• Topical emollients
• Topical steroids
• Phototherapy with ultraviolet light (UVB) may be used in severe cases
• Oral steroids may be used in severe cases

Question 10

When does atopic eruption of pregnancy get better

Answer 10

After delivery

Question 11

Melasma

Answer 11

Mask of pregnancy - increased pigmentation to patches of the skin on the face

Question 12

Presentation of melasma

Answer 12

Usually symmetrical and flat, affecting sun-exposed areas

Question 13

Causes of melasma

Answer 13

Increased hormones in pregnancy
COCP and HRT
Sun exposure
Thyroid disease

Question 14

Management of melasma

Answer 14

No active treatment if the appearance is acceptable

Management is with:
- Avoiding sun exposure and using suncream

• Makeup (camouflage)
• Skin lightening cream (e.g. hydroquinone or retinoid creams), although not in pregnancy and only under specialist care
• Procedures such as chemical peels or laser treatment (not usually on the NHS)

Question 15

Pyogenic Granuloma

Answer 15

Lobular capillary haemangioma - benign, rapidly growing tumour of capillaries

Question 16

How does pyogenic granuloma present

Answer 16

Rapidly growing lump that develops over days

Often occur on fingers, upper chest, back, neck or head

Discrete lump with a red or dark appearance

Question 17

What triggers pyogenic granuloma

Answer 17

Pregnancy
Hormonal contraceptives
Minor trauma
Infection

Question 18

Complication of pyogenic granuloma

Answer 18

May cause profuse bleeding and ulceration if injured

Question 19

Differentials for pyogenic granuloma

Answer 19

Nodular melanoma

Question 20

Management of pyogenic granuloma

Answer 20

Normally resolves after pregnancy

Treatment:

• surgical removal
• histology to exclude nodular melanoma

Question 21

Pemphigoid Gestationis

Answer 21

Rare autoimmune skin condition that occurs in pregnancy

Question 22

Pathophysiology of pemphigoid gestationis

Answer 22

Autoantibodies are created that damage the connection between the epidermis and the dermis

Causes the epidermis and dermis to separate, creating a space that can fill with fluid, resulting in bullae

Question 23

When does pemphigoid gestationis normally occur

Answer 23

Second or third trimester

Question 24

Presentation of pemphigoid gestationis

Answer 24

Itchy red papular or blistering rash around the umbilicus

Spreads to other parts of the body

Over several weeks, large fluid-filled blisters form

Question 25

How does pemphigoid gestationis resolves

Answer 25

Resolves after birth - blisters heal without scarring

Question 26

Treatment of pemphigoid gestationis

Answer 26

Topical emollients
Topical steroids
Oral steroids - severe cases
Immunosuppressants may be required where steroids are inadequate
Antibiotics may be necessary if infection occurs

Question 27

Risks of pemphigoid gestationis to baby

Answer 27

Fetal growth restriction

Preterm delivery

Blistering rash after delivery (as the maternal antibodies pass to the baby)