Pregnancy-Related Rashes Flashcards

1
Q

What is polymorphic eruption of pregnancy?

A
  • an itchy rash that begins in the stretch marks of the abdomen (striae)
  • it starts in the third trimester

(also called pruritic + urticarial papule + plaques of pregnancy)

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2
Q

What are the 3 key features of polymorphic eruption?

A
  • urticarial papules (raised itchy lumps)
  • wheals (raised itchy areas of skin)
  • plaques (larger inflamed areas of skin)
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3
Q

What is urticaria (hives)?

A

a family of conditions associated with transient wheals

wheals are transient elevations of the skin due to dermal oedema

they are often pale centrally with an erythematous rim

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4
Q

What is the difference between a papule and a plaque?

A

Papule:

  • an elevated, solid, palpable lesion that is < 1cm in diameter

Plaque:

  • a circumscribed palpable lesion that is > 1cm in diameter
  • can result from a coalescence of papules
  • usually elevated
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5
Q

What is involved in the management of polymorphic eruption?

A
  • topical emollients
  • topical steroids
  • oral antihistamines
  • oral steroids (severe cases)

the condition will improve towards the end of pregnancy / with delivery

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6
Q

What is atopic eruption of pregnancy?

A
  • eczema that flares up during pregnancy
  • can occur in women with pre-existing eczema and those who have never had it
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7
Q

When does atopic eruption present?

A

first and second trimester

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8
Q

What are the 2 types of atopic eruption?

A
  • E-type / eczema-type
  • P-type / prurigo-type
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9
Q

What is the presentation of E-type atopic eruption?

A

eczematous, inflamed, red + itchy skin

tends to affect:

  • insides of the elbows
  • back of the knees
  • neck + face
  • chest
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10
Q

What is the typical presentation of P-type atopic eruption?

A

intensely itchy papules (spots)

tends to affect:

  • abdomen
  • back
  • limbs
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11
Q

What is involved in the management of atopic eruption?

A
  • topical emollients
  • topical steroids
  • oral steroids (in severe cases)
  • phototherapy with UVB light (in severe cases)
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12
Q

What is melasma?

A
  • increased pigmentation to patches of skin on the face
  • usually symmetrical + flat
  • affects sun-exposed areas
  • also called “mask of pregnancy”
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13
Q

What else can melasma be associated with?

A
  • COCP + HRT
  • sun exposure
  • family history
  • thyroid disease

(it is thought to be due to an increase in female sex hormones)

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14
Q

What is the main treatment for melasma?

A

there is no active treatment if the appearance is acceptable to the woman

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15
Q

What steps can be taken in the management of melasma?

A
  • avoid sun exposure / use suncream
  • makeup (camouflage)
  • skin lightening cream
    • hydroquinone / retinoid creams
    • NOT used in pregnancy
    • ONLY under specialist care
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16
Q

What is pyogenic granuloma?

A
  • a benign, rapidly growing tumour of capillaries
  • it is also called “lobular capillary haemangioma”
17
Q

How does a pyogenic granuloma appear?

What else can cause it?

A
  • a single, discrete lump** with a **red or dark appearance
  • rapidly growing
  • develops over days up to 1-2cm in size
  • can be associated with hormonal contraceptives or triggered by minor trauma/infection
can cause ulceration / profuse bleeding if injured
18
Q

Where are pyogenic granulomas typically found?

A
  • fingers
  • upper chest
  • back
  • neck / head
19
Q

What is involved in the management of pyogenic granuloma?

A
  • exclude other differentials (incl. malignancy)
  • they usually resolve after delivery in pregnancy
  • if not, surgical removal with histology is performed
20
Q

What is pemphigoid gestationis?

A
  • a rare autoimmune blistering skin condition that occurs in pregnancy
  • occurs during second / third trimester
21
Q

How does pemphigoid gestationis present?

A
  • starts with an itchy, red papular rash around the umbilicus
  • this spreads outwards to other parts of the body
  • over several weeks, large fluid-filled blisters form
22
Q

Why does pemphigoid gestationis occur?

A
  • autoantibodies damage the connection between the dermis + epidermis
  • autoantibodies are produced in response to placental tissue
  • the dermis + epidermis separate from each other
  • this creates a space that can fill with fluid**, resulting in **large fluid-filled blisters (bullae)
23
Q

How does the rash associated with pemphigoid gestationis change during pregnancy?

A
  • it goes through stages of improvement + worsening during pregnancy
  • it resolves without treatment after delivery
  • the blisters heal without scarring
24
Q

What is involved in the management of pemphigoid gestationis?

A
  • topical emollients
  • topical steroids
  • oral steroids (severe cases)
  • immunosuppressants (where steroids are inadequate)
  • antibiotics (if infection occurs)
25
Q

What are the risks to the baby associated with pemphigoid gestationis?

A
  • fetal growth restriction
  • preterm delivery
  • blistering rash after delivery (as maternal antibodies pass to the baby)