Skin Disease in Pregnancy

Question 1

Physiological changes

Answer 1

• Hyperpigmentation
• Striae gravidarum
• Hair and nail changes
• Vascular - angiomas, spider naevi
• Greasier skin
• Pruritis

Question 2

Common skin diseases in pregnancy

Answer 2

• Atopic eruption of pregnancy
• Acne vulgaris or rosacea
• Psoriasis
• Infections (candida, viral warts, varicella)
• Infestations (scabies)
• Autoimmune (SLE, pemphigus)

Question 3

Atopic eruption of pregnancy

Answer 3

• Commonest pregnancy rash
• Overlap between pruritic folliculitis, prurigo and atopic eczema
• Earlier onset in pregnancy (< 3rd trimester)
• Trunk and limbs involved
• Ecxematous (E-type AEP)
  
  • Rough and red patches on face, neck, creases of elbows and backs of knees
• Prurigo (P-type AEP)
  
  • Bumps on abdomen, arms and legs

Question 4

Treatment of AEP

Answer 4

• Emollients
• Topical steroids
• Antihistamines
• Narrow band UVB
• Oral steroids if severe

Question 5

Polymorphic eruption of pregnancy

Answer 5

• 3rd trimester or postpartum
• Pruritic eruption lower abdomen and striae with umbilical sparing and distant spread
• No autoimune associated

Question 6

Treatment of polymorphic eruption of pregnancy

Answer 6

• Provide self-care advice to relieve itching
• Emollients
• Topical corticosteroids
• Sedating antihistamine if affecting sleep

Question 7

Pemphigoid Gestationis

Answer 7

• 2nd or 3rd trimester or puerperium
• Urticarial lesions, wheals and bullae in the umbilical area
• Autoimmune binding of IgG to basement membrane
• Usually recurs
• Can lead to premature delivery, fetal growth restriction and transient blistering on the infant

Question 8

Treatment of pemphigoid gestationis

Answer 8

• Refer to dermatology and obstetrics
• Topical corticosteroids
• Antihistamines
• Oral steroids if severe
• Additional surveillance for fetal problems