Skin Disease in Pregnancy

Question 1

Skin disease in pregnancy

Answer 1

Skin diseases in pregnancy:

• Pemphigoid gestationis
• Polymorphic eruption of pregnancy / Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP)
• Prurigo of pregnancy
• Pruritis folliculitis
• Atopic eczema

Changes in physiology during pregnancy affect the skin:

Pre-existing conditions (e.g. acne can worsen during pregnancy)

• Acne flares in 3rd trimester – oral or topical erythromycin, retinoids contraindicated

Increased pigmentation (face, areola, abdo midline) common

Spider naevi affecting face, arms, upper torso

Broad pink linear striae – striae gravidarum common over lower abdo and thighs

Hand and nipple eczema common post-partum

Psoriasis – topical steroids, methotrexate contraindicated

Question 2

Pemphigoid gestationis

Answer 2

Pemphigoid gestationis -> rare pruritic AI bullous disorder

o Presents in late 2nd or 3rd trimester

o SS: lesions begin on abdomen 50% of time à widespread clustered blisters, sparing face

o M: relive pruritis and stop new blister formation, use potent topical steroids or oral prednisolone

Question 3

Polymorphic eruption of pregnancy (PEP)

Answer 3

Polymorphic eruption of pregnancy (PEP) -> 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 -> 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

M: symptomatic treatment

C: preterm delivery and SGA births, no increase in pregnancy loss, recurs in most subsequent pregnancies

Question 4

Prurigo of pregnancy

Answer 4

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

Question 5

Pruritis folliculitis

Answer 5

Pruritis folliculitis -> 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) à

o M: topical steroids

Question 6

Atopic eczema

Answer 6

Atopic eczema -> common pruritic condition affecting up to 5% of population

o SS: causes commonest pregnancy rash

o M: emollients and bath additives