Skin Disease in pregnancy Flashcards
What skin diseases can occur in pregnancy?
o Pemphigoid gestationis
o Polymorphic eruption of pregnancy / Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP)
o Prurigo of pregnancy
o Pruritis folliculitis
o Atopic eczema
What changes in physiology happen during pregnancy and affect the skin?
o Pre-existing conditions (e.g. acne can worsen during pregnancy)
§ Acne flares in 3rd trimester – oral or topical erythromycin, retinoids contraindicated
o Increased pigmentation (face, areola, abdo midline) common
o Spider naevi affecting face, arms, upper torso
o Broad pink linear striae – striae gravidarum common over lower abdo and thighs
o Hand and nipple eczema common post-partum
o Psoriasis – topical steroids, methotrexate contraindicated
Summarise Pemphigoid gestationis
rare pruritic AI bullous disorder
o Presents in late 2nd or 3rd trimester
o SS: lesions begin on abdomen 50% of time -> widespread clustered blisters, sparing face
o M: relive pruritis and stop new blister formation, use potent topical steroids or oral prednisolone
Summarise Polymorphic eruption of pregnancy
self-limiting pruritic inflammatory disorder
o AKA: Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP) – Umbilical sparing rash
o Presents in 3rd trimester or immediately post-partum
o SS: begin on lower abdomen, involving pregnancy striae à extend to thigh, buttocks, legs, arms, sparing umbilicus and rarely involves face, hands, feet
§ In 70% of cases, lesions become confluent and widespread, resemble erythroderma
o M: symptomatic treatment
o C: preterm delivery and SGA births, no increase in pregnancy loss, recurs in most subsequent pregnancies
Summarise prurigo of pregnancy
common pruritic disorder
o Affects 20% of normal pregnancies, do LFTs to exclude obstetric cholestasis
o Starts 3rd trimester (25-30 weeks) of pregnancy, resolve after delivery, no effect on mother or baby
o SS: present as excoriated papules on extensor limbs, abdo, shoulder
o M: symptomatic treatment + topical steroids and emollients
Summarise pruritis folliculitis
à pruritic follicular eruption with papules and pustules affecting trunk can involve limbs
o 2nd or 3rd trimester, resolve a week after delivery
o SS: acne (considered a type of hormone-induced acne)
o M: topical steroids
Summarise atopic eczema
ccommon pruritic condition affecting up to 5% of population
o SS: causes commonest pregnancy rash
o M: emollients and bath additives
