Skin

Question 1

Pre-existing conditions
- Ddx
- Investigations
- Risks
- Management

Answer 1

Psoriasis
- Generally improves
- Generally most treatment are safe but methotrexate

Eczema
- Worsens
- Topical steroids are safe

Question 2

Coincident conditions
- Ddx
- Investigations
- Risks
- Management

Answer 2

Acne
- Vitamin A and tetracycline are contraindicated in pregnancy

Acne rosacea
- Often worsens in pregnancy

Erythema nodosum
- Check for TB, sarcoidosis with a CXR
- Check for strep infection, IBD, recent meds with sulphonamides

Erythema multiforme
- Can be associated with viral infections particularly HSV or drugs or pregnancy

Pityriasis rosea
- Can be associated with pregnancy may be related to human herpes virus 6.

Question 3

Dermatoses specific to pregnancy
- Ddx
- Investigations
- Risks
- Management

Answer 3

Polymorphic eruption of pregnancy
Features
- Umbilicus sparing, generally trunk and torsion
- 1;200, more common in primips and multiples
- Pruritic urticartial papules and plaques

Risks
- None

Management
- Menthol cream
- Hydrocortisone cream & ointment
- Antihistamine
- Systemic steroids

Pemphigoid gestationis
- 1;10000 to 50000
- Anytime but generally 3rd trimester, abdominal rash spreading from umbilicus
- Same rash which can become vesicles and large tense bullae
- AI: Blinding of circulating complement fixing IgG antibodies to the basement membrane of the skin
- Diagnosed by skin biopsy showing complement in BM zone
- Risks: IUGR
- Same treatment, can reoccur in next pregnancy

Atopic eruption of pregnancy
- 1;300 pregnancies
- Basically ezcema