Skin Eruptions Specific to Pregnancy Flashcards
What are the 4 dermatosis of pregnancy?
1- atopic eruption of pregnancy
2- pemphigoid gestationis
3- polymorphic eruption of pregnancy
4- Intrahepatic cholestasis
Among physiological skin changes in pregnancy, what is the most common change?
Melasma , 75 % of pregnant women
Often in 2nd&3rd trimester.
📌 all treatments of melasma ( hydroquinone, retinol, laser …) are contraindicated in pregnancy.
📌 in pregnancy: just sunblock.
What is the main cause of stariae gravidarum? What are the risk factors?
📌 Rupture of dermal elastic fibers
[ changes in the connective tissues ]
📌 Risk factors: family histor, dark skinned women, excessive abdominal distention.
What is the treatment of striae gravidarum?
Emollients
No evidence that vit E or tea tree oil have any special value.
What is the incidence of spider naevi in pregnancy as a physiological change ? When they appear?
66 % in caucasians
11 % in black
🚩face ,neck , hands, arms
🚩in the 2nd trimester, usually disappear around 3rd month postnatally.
🚩 treatment: sclerotherapy , laser
Acute telogen effluvium, when it happens?, when the recovery?
3 - 6 months postpartum
Recovery: within 9- 12 months
What is the percentage of pregnant women affected by pruritus in the absence of any biochemical disorder? What is the recurrence rate?
Incidence: 18 %
Recurrence in subsequent pregnancies: 80 %
How to take a history from a pregnant woman with pruritus?
1- duration
2- progression of the condition
3- relieving or exacerbating factors
& associated symptoms: pain, redness, burning.
4- family hx
5- job - travel
6- past medical hx: asthma, hay fever
7- drug Hx + allergies
8- past dermatological problems
9- previous treatment tried for this condition
10- impact of this condition on quality of life.
What is the most common dermatosis of pregnancy?
Atopic eruption 1 / 300
Other terminology of this :
(Prurigo gestationis - pruritic folliculitis - eczema of pregnancy)
What are the risk factors of atopic eruption in pregnancy? What is the parthogenesis?
family history of atopy
80 % 👉 primary condition
20% 👉 exacerbation of preexisting condition
📌 pathogenesis : pregnancy specific immunological changes
How atopic eruption of pregnancy presented?
2nd or 3rd trimester ( can occur earlier)
Erythematous, excoriated Nodules or papules on the face, neck, chest, extensor surfaces of the limbs
How is atopic eruption of pregnancy diagnosed?
Clinically- no other investigations needed
Histopathology : non specific
Immunofluorescence: negative
When does atopic eruption of pregnancy improve?
After delivery
No postpartum exacerbation
No data about recurrence
What are the treatment options for atopic eruption of pregnancy?
Symptomatic: oatmeal bath - topical antipruritic: 1% menthol- calamine
Topical steroids- oral antihistamine- ultraviolet light to help alleviate symptoms
📌 cool environment is recommended
📌 topical benzoyl peroxide/ erythromycin with zinc acetate lotion are sometimes effective
What is the incidence of polymorphic eruption of pregnancy?
1/ 160 - 1/ 300 of pregnancies
How is polymorphic eruption of pregnancy ( PUPPP) presents?
🔴Periumbilical sparing
Pruritic urticaria papules & plaques within the abdominal striae/ progresses to trunk &extremities sparing ( palms -soles - face)
🚩Usually in 3rd trimester or immediately postpartum
🚩 self-limiting : 4-6w from the time of onset
What are the risk factors for polymorphic eruption of pregnancy (PUPPP) ?
Nulliparity - multiple pregnancies
Any other cause of over distension of the abdominal skin
How is PUPPP diagnosed?
Clinically
🍀Biopsy ONLY: if no response to intial treatment or there is a doubt in the diagnosis
🍀 immunofluorescence: ( direct/indirect) : NEGATIVE [ help in DD with pemphigoid gestationis]
What is the first line treatment for polymorphic eruption of pregnancy ( PUPPP)?
1-TOPICAL STEROIDS
Oral steroids are virtually never required
2- antihistamines / emollients
What is the recurrence rate of PUPPP?
RARE
What is the impact of PUPPP on maternal & fetal outcomes?
NOOO impact
When does pemphigoid gestationis ( herpes gestationis) occur?
After 2nd & 3rd trimester,
& rarely after delivery
What is the incidence rate of pemphigoid gestationis?
1/1700 - 1/ 50,000
How does pemphigoid gestationis appear ?
1-Urticarial papules &plaques: around the umbilicus extending to extremities, palms & soles
With MUCOSAL SPARING
2- Blisters; around the edge of the rash
What is the cause behind pemphigoid gestationis?
It’s believed that autoimmune condition with antibodies against target antigen ( proteins of placenta & skin)
** corelation with HAlA type DR3-DR4
How is pemphigoid gestationis diagnosed?
SKIN BIOPSY is necessary
2 samples : from perilessional skin
1 for histology
1 for immunofluorescence
What is the treatment of pemphigoid gestationis?
1- Topical & oral steroids
Antihistamines
2- antibiotics: can be helpful
3- CYCLOSPORINE safe in pregnancy
🚩 alendronic acid is contraindicated in pregnancy
4- cases unresponsive to systemic steroids may benefit from immunophoresis
Why is CYCLOSPORINE considered safe in pregnancy & contraindicated in breastfeeding?
Owing to the potential for immunosuppression & neutropenia
What is the course of pemphigoid gestationis in pregnancy?
Exacerbations & remissions are characteristic
📌 flare up at delivery 75% of patients
📌 flare up postpartum: common
When does pemphigoid gestationis resolve?
2-6 weeks postpartum
What is the recurrence of pemphigoid gestationis?
There is a recurrence in subsequent pregnancies with earlier onset & increasing severity
🍀 Also with: OC or during MENSTRUATION
What are the fetal outcomes in a pregnancy complicated by pemphigoid gestationis?
1- IUGR 👉 monthly scan
2- preterm delivery: conflicting evidence
3- 1/10 babies will devlop SKIN LESIONS due to passive transfer of antibodies
What is the autoimmune disease that associated with pemphigoid gestationis?
GRAVES DISEASE
👉👉 consider TFTs
When to refer a pregnant with skin eruption to obstetric consultant?
1- pemphigoid gestationis
2- Intrahepatic cholestasis
When to refer a pregnant with a skin eruption to a dermatologist?
1-Any skin eruption where initial management fails or associated with systemic symptoms
2- pemphigoid gestationis
