Pregnancy-Related Rashes Flashcards
What is polymorphic eruption of pregnancy?
- 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)
What are the 3 key features of polymorphic eruption?
- urticarial papules (raised itchy lumps)
- wheals (raised itchy areas of skin)
- plaques (larger inflamed areas of skin)
What is urticaria (hives)?
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
What is the difference between a papule and a plaque?
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
What is involved in the management of polymorphic eruption?
- topical emollients
- topical steroids
- oral antihistamines
- oral steroids (severe cases)
the condition will improve towards the end of pregnancy / with delivery
What is atopic eruption of pregnancy?
- eczema that flares up during pregnancy
- can occur in women with pre-existing eczema and those who have never had it
When does atopic eruption present?
first and second trimester
What are the 2 types of atopic eruption?
- E-type / eczema-type
- P-type / prurigo-type
What is the presentation of E-type atopic eruption?
eczematous, inflamed, red + itchy skin
tends to affect:
- insides of the elbows
- back of the knees
- neck + face
- chest
What is the typical presentation of P-type atopic eruption?
intensely itchy papules (spots)
tends to affect:
- abdomen
- back
- limbs
What is involved in the management of atopic eruption?
- topical emollients
- topical steroids
- oral steroids (in severe cases)
- phototherapy with UVB light (in severe cases)
What is melasma?
- increased pigmentation to patches of skin on the face
- usually symmetrical + flat
- affects sun-exposed areas
- also called “mask of pregnancy”
What else can melasma be associated with?
- COCP + HRT
- sun exposure
- family history
- thyroid disease
(it is thought to be due to an increase in female sex hormones)
What is the main treatment for melasma?
there is no active treatment if the appearance is acceptable to the woman
What steps can be taken in the management of melasma?
- avoid sun exposure / use suncream
- makeup (camouflage)
- skin lightening cream
- hydroquinone / retinoid creams
- NOT used in pregnancy
- ONLY under specialist care
What is pyogenic granuloma?
- a benign, rapidly growing tumour of capillaries
- it is also called “lobular capillary haemangioma”
How does a pyogenic granuloma appear?
What else can cause it?
- 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
Where are pyogenic granulomas typically found?
- fingers
- upper chest
- back
- neck / head
What is involved in the management of pyogenic granuloma?
- exclude other differentials (incl. malignancy)
- they usually resolve after delivery in pregnancy
- if not, surgical removal with histology is performed
What is pemphigoid gestationis?
- a rare autoimmune blistering skin condition that occurs in pregnancy
- occurs during second / third trimester
How does pemphigoid gestationis present?
- 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
Why does pemphigoid gestationis occur?
- 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)
How does the rash associated with pemphigoid gestationis change during pregnancy?
- it goes through stages of improvement + worsening during pregnancy
- it resolves without treatment after delivery
- the blisters heal without scarring
What is involved in the management of pemphigoid gestationis?
- topical emollients
- topical steroids
- oral steroids (severe cases)
- immunosuppressants (where steroids are inadequate)
- antibiotics (if infection occurs)
What are the risks to the baby associated with pemphigoid gestationis?
- fetal growth restriction
- preterm delivery
- blistering rash after delivery (as maternal antibodies pass to the baby)
