Skin disease in pregnancy Flashcards
What are some common physiological skin changes in pregnancy?
Increased pigementation of
- Face
- Areolae
- Axillae
- Abdominal midline (linea nigra)
Spider naevi of face, arms, upper torso
Striae gravidarum (broad pink linear striae) on lower abdomen and thighs
Pruritus
What is shown?
Linea nigra
What is shown?
Striae gravidarum
How common is pruritus during pregnancy? What investigation should be done?
20% of normal pregnancies affected
But must exclude obstetric cholestasis so check LFTs
What happens to pre-existing skin diseases in pregnancy?
Eczema - may worsen, especially hand and nipple eczema postpartum; atopic eczema is the most common rash in pregnancy
Acne - may improve initially then worsen in the third trimester
Acne rosacea - worsens often
Psoriasis - remains unchanged in 40%, improves in 40% and worsens in 20%
What is the commonest pregnancy rash?
Atopic eczema
It is a common pruritic skin condition affecting 1–5% of the general population and causes the commonest pregnancy rash
How can atopic eczema be treated?
- Emollients
- Bath additives
How can pre-existing psoriasis be treated in pregnancy? What is contraindicated?
Topical steroids
Methotrexate is contraindicated
How can acne be treated during pregnancy? What is contraindicated?
Oral or topical erythromycin
Retinoids are contraindicated
Name 4 dermatoses specific to pregnancy.
- Pemphigoid gestationis (PG) - autoimmune bullous
- Polymorphic eruption of pregnancy (PEP) - pruiritic, inflammatory
- Prurigo of pregnancy - pruritic, excoriated papules
- Pruritic follicilitis of pregnancy (PF) - pruritic folicular papules and pustules
What condition is shown?
Clue: usually begins on abdomen in late 2nd/3rd trimester and progresses to widespread clustered blisters sparing the face.
Pemphigus gestationis
What condition is shown?
Clue: Presents in 3rd trimester +/- immediately postpartum. Begins on lower abdomen, involving striae, extends to buttocks, thighs, legs and arms, sparing the umbilicus and rarely involving the face, hands and feet.
Polymorphic eruption of pregnancy (PEP)
What condition is shown?
Clue: Starts ~25-30 weeks and resolves after delivery. Affects extensor surfaces of limbs, abdomen and shoulders. Common in atopy hx.
Prurigo of pregnancy
What condition is shown?
Clue: Starts in 2nd/3rd trimester and resolves with delivery. Follicular eruptions, with papules, pustules that mainly affect the trunk but can involve limbs. Similar to acne.
Pruritic folliculitis of pregnancy
What is pemphigoid gestationis and how common is it? When is the onset?
Rare pruritic autoimmune bullous disorder,
affecting 1 in 60,000 pregnancies.
Presents in the late second or third trimester
Describe the clinical features of PG, including diagnosis.
Appearance: Lesions begin on the abdomen in 50% and –> widespread clustered blisters sparing the face.
Diagnosis: clinical appearance and by direct immunofluorescence.
What is the prognosis of PG?
Common exacerbations and remissions, and flares postpartum in 75% of cases.
PG recurs in most subsequent pregnancies
What is the management of PG?
Aim to relieve pruritus and prevent new blister formation:
- Potent topical steroids
- +/- oral prednisolone.
What is polymorphic eruption of pregnancy? How common is it and when is the onset?
- PEP is a pruritic inflammatory disorder
- Affects 1 in 160 pregnancies - 75% of affected pregnancies are primagravida
- Usually presents in the 3rd trimester +/- postpartum
What are the clinical features of PEP?
Begins on the lower abdomen involving pregnancy striae, and extends to thighs, buttocks, legs and arms,
Spares the umbilicus and rarely involves face, hands and feet.
In 70% of patients the lesions become confluent and widespread, resembling a toxic erythema.
What is the management of PEP? What is the prognosis?
Symptomatic treatment is sufficient
No tendency to recur
What is prurigo of pregnancy and how common is it? When is the onset?
Common pruritic disorder, more common in women with a history of atopy.
Affects 1 in 300 pregnancies
Onset is at 25-30 weeks
What are the clinical features of prurigo of pregnancy?
Excoriated papules on extensor limbs, abdomen and shoulders
What is the management of prurigo? What is the prognosis?
Treatment is symptomatic with topical steroids and emollients.
Resolves after delivery, with no effect on the mother or baby.
What are the clinical features of pruritic folliculitis of pregnancy?
- Pruritic folliculat eruption
- Papules and pustules
- Mainly affect the trunk but can affect the limbs
- Look like acne lesions and sometimes are considered a type of hormonally-induced acne
When is the onset of pruritic folliculitis of pregnancy? What is the management?
Onset usually in 2nd/3rd trimester and resolves after delivery
Topical steroids are effective
