Pregnancy-Related Rashes Flashcards
Polymorphic Eruption of Pregnancy
Pruritic and urticarial papules and plaques of pregnancy
When does polymorphic eruption of pregnancy normally occur
During the third trimester
Presentation of polymorphic eruption of pregnancy
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)
When does polymorphic eruption of pregnancy get better
Gets better towards the end of pregnancy and after delivery
Management of polymorphic eruption of pregnancy
Symptomatic relief with:
- Topical emollients
- Topical steroids
- Oral antihistamines - chlorphenamine for sleep
- Oral steroids may be used in severe cases
Atopic Eruption of Pregnancy
Eczema that flares up during pregnancy in woman with existing eczema or never having eczema previously
When does atopic eruption of pregnancy occur
First and second trimester
Types of atopic eruption of pregnancy
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.
Management of atopic eruption of pregnancy
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
When does atopic eruption of pregnancy get better
After delivery
Melasma
Mask of pregnancy - increased pigmentation to patches of the skin on the face
Presentation of melasma
Usually symmetrical and flat, affecting sun-exposed areas
Causes of melasma
Increased hormones in pregnancy
COCP and HRT
Sun exposure
Thyroid disease
Management of melasma
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)
Pyogenic Granuloma
Lobular capillary haemangioma - benign, rapidly growing tumour of capillaries
How does pyogenic granuloma present
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
What triggers pyogenic granuloma
Pregnancy
Hormonal contraceptives
Minor trauma
Infection
Complication of pyogenic granuloma
May cause profuse bleeding and ulceration if injured
Differentials for pyogenic granuloma
Nodular melanoma
Management of pyogenic granuloma
Normally resolves after pregnancy
Treatment:
- surgical removal
- histology to exclude nodular melanoma
Pemphigoid Gestationis
Rare autoimmune skin condition that occurs in pregnancy
Pathophysiology of pemphigoid gestationis
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
When does pemphigoid gestationis normally occur
Second or third trimester
Presentation of pemphigoid gestationis
Itchy red papular or blistering rash around the umbilicus
Spreads to other parts of the body
Over several weeks, large fluid-filled blisters form
How does pemphigoid gestationis resolves
Resolves after birth - blisters heal without scarring
Treatment of pemphigoid gestationis
Topical emollients
Topical steroids
Oral steroids - severe cases
Immunosuppressants may be required where steroids are inadequate
Antibiotics may be necessary if infection occurs
Risks of pemphigoid gestationis to baby
Fetal growth restriction
Preterm delivery
Blistering rash after delivery (as the maternal antibodies pass to the baby)
