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MRCOG Part 2 > Skin Eruptions in Pregnancy - TOG article > Flashcards

Skin Eruptions in Pregnancy - TOG article Flashcards

1
Q

What proportion of pregnant mothers report melasma (chloasma gravidarum)?

A

75%

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2
Q

What treatments for melasma have been tried?

A

Avoid sunlight exposure - most important

Topical bleaching
Hydroquinones (not licenced in UK)
Retinoids\Steroids
Chemical peel
Laser treatment
Dermabrasion

Not in preg/breastfeeding, limited response

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3
Q

What causes striae?

A

Rupture of dermal elastic fibres

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4
Q

What are the risk factors for developing striae?

A

Personal/family history
Dark skinned women
Excessive abdominal distension
No evidence for Vitamin E, tea tree oil

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5
Q

What happens to hidradenitis suppurativa in pregnancy

A

Tends to improve - decreased apocrine activity

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6
Q

What happens to sebaceous glands in pregnancy?

A

Increased activity in third trimester (acne effect variable)

May develop Montgomery tubercles (follicles) - hypertrophic glands, non pigmented elevations in primary areola

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7
Q

What is the prevalence of spider naevi, when do they appear and what is the treatment in pregnancy?

A

66% in Caucasians, 11% in black
Appear T2, disappear 3/12 postnatal
Sclerotherapy/laser to lower extremities if required

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8
Q

What happens to eccrine glands in pregnancy?

A

Increased secretion towards T3

Causes prickly heat (miliaria) and hyperhidrosis what can cause pruritis

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9
Q

What causes increased hair growth antenatally?

A

Prolongation of anagen phase

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10
Q

What is acute telogen effluvium and when does it occur?

A

Generalised hair shedding with diffuse non-scarring alopecia

Occurs 3-6/12 PN, spontaneous recovery 9-12/12, most recover completely

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11
Q

What happens to nails in pregnancy?

A

Grow faster

May become dystrophic, brittle

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12
Q

What happens to mucosa in pregnancy?

A

Pigmentation, hyperaemia, hypertrophy - may bleed

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13
Q

How many pregnancies are affected by pruritis with no underlying haematological/biochemical disorder?

Which sites most affected and when?

What is recurrence rate

A

18%
Scalp and abdomen, T3 and peaks 1/12 pre delivery

Recurrence rate up to 80%

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14
Q

When do dermographism and urticaria commonly occur?

A

Last half of pregnancy

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15
Q

Which pregnancy dermatoses can cause IUGR, prematurity and stillbirth?

A

Intrahepatic cholestasis of pregnancy and pemphigoid gestationis

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16
Q

What is the prevalence of OC?

A
  1. 7% in multiethnic populations

1. 2-1.5% of women with Indian/Pakistani origin

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17
Q

What other investigations should be performed when considering OC as a diagnosis?

A

Viral screen
Liver autoimmune
Pre eclampsia screen
Liver USS

If liver fx improves/worsens rapidly - unlikely OC

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18
Q

What is the recurrence rate of OC?

A

60-70%

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19
Q

What is the dose of ursodeoxycholic acid?

A

15mg/kg OD or in divided doses

Minimal evidence for emollients, antihistamines, vitamin K

20
Q

What is atopic eruption of pregnancy also known as?

A

Prurigo gestationis (Besnier)
Nurse’s early-onset prurigo of pregnancy
Pruritic folliculitis of pregnancy
Eczema in pregnancy

21
Q

What is the incidence of atopic eruption of pregnancy?

A

1 in 300

22
Q

What is a risk factor for atopic eruption of pregnancy?

A

FHx of atopy

23
Q

What are the immunological changes in atopic eruption of pregnancy?

A

Reduced cellular immunity and decreased Th1 cytokines

Dominant humoral immunity and increased Th2 cytokines

24
Q

In what % of patients does atopic eruption of pregnancy occur as the primary condition?

When does it occur?

A

80%
Rest exacerbation of pre-existing

Anytime but most T2 and T3. Improves following delivery

25
Q

What presents as erythematous, excoriated nodules or papules on the face, neck, chest, extensor surfaces of limbs, trunk?

A

Atopic eruption of pregnancy

26
Q

What is the risk of recurrence of atopic eruption of pregnancy and what effect on mum/fetus?

A

Limited data. No adverse effects.

27
Q

What is the treatment of atopic eruption of pregnancy?

A

Symptom relief - oat bath, emollient, topical antipruritics, topical stroids, UV light

Topical benzoyl peroxide, erythromycin with zinc acetate lotion

28
Q

What is polymorphic eruption of pregnancy also known as?

A 
Pruritic urticarial papules and plaques of pregnancy
Toxic erythema of pregnancy
Bourne's toxaemic rash of pregnancy
Linear IgM dermatosis of pregnancy
Nurse's late-onset prurigo
29
Q

What is the incidence of polymorphic eruption of pregnancy?

When does it present?

A

1 in 160-300

T3 or immediately postpartum. Resolves 4-6/52 from onset

30
Q

What are the risk factors for polymorphic eruption of pregnancy?

A

Nulliparity
Multiple pregnancy
Overdistension of abdominal skin

31
Q

What presents as erythematous papules in striae with periumbilcal sparing, to the trunk and extremities (not palm/soles/face)?

A

Polymorphic eruption of pregnancy

32
Q

Which condition shows histologically non-specific, negative immunofluoresence

A

Atopic eruption of pregnancy

33
Q

Which condition histologically shows lymphocytic vasculitis with eosinophils and oedema of the papillary dermis? Later biopsies show spongiosis, hyper- and parakeratosis? Negative immunfluoresence.

A

Polymorphic eruption of pregnancy

34
Q

What is the treatment for polymorphic eruption of pregnancy

A

Symptomatic - topical steroids, antihistamines, emollients

35
Q

What is the recurrence and impact on mum/fetus in PEP?

A

Rare recurrence

No adverse impact

36
Q

What is pemphigoid gestationis also known as?

A

Pregnancy-related bullous pemphigoid

Herpes gestationis

37
Q

What is the incidence of pemphigoid gestationis and when does it occur?

A

1 in 1700-50,000

Any time after T2, rarely immediately after childbirth

38
Q

What presents with a rash around the umbilicus, urticarial papules and papules which join to form bullae to trunk, extremities, palms, soles (mucosal sparing)? Blisters after a few weeks around the edge of the rash?

A

Pemphigoid gestationis

39
Q

What is the mechanism of pemphigoid gestationis and how is diagnosis made?

A

Autoimmune antibodies against placental proteins and skin

Biopsy necessary

40
Q

Which haplotypes are associated with pemphigoid gestationis?

A

HLA DR3 and 4

41
Q

Which condition histologically shows degenerative changes in basal cells with blister in epidermis and then subsequently between Malphigian layer and subepidermal basement membrane?
Direct and indirect (blood/blister fluid) immunofluorescence positive.

A

Pemphigoid gestationis

42
Q

What is the treatment of pemphigoid gestationis?

A

Symptom control - topical/PO steroids and antihistamines
Caution with ccs - osteoporosis risk

Cyclosporin - appears safe but avoid in breastfeeding

43
Q

How many patients experience a flare of pemphigoid gestationis at the time of delivery?
When does postnatal flare resolve?

A

75% - common postnatally

Resolve 2-6/52

44
Q

What is the recurrence of pemphigoid gestationis?

A

May occur - earlier onset and more severe

Also with COCP/menstration

45
Q

What is the impact of pemphigoid gestationis on the fetus?

A

IUGR - scans monthly
Conflicting evidence re:PTL
1 in 10 newborns mild self limiting skin lesions

46
Q

What other conditions are associated with pemphigoid gestationis?

A

Autoimmune - Graves’ - consider TFTs

47
Q

Which patients should be referred to a dermatologist?

A

Pemphigoid gestationis
PEP or atopic eruption where initial management fails
Skin eruptions with systemic symptoms

MRCOG Part 2 (97 decks)

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