Skin Eruptions Specific to Pregnancy Flashcards

1
Q

What are the 4 dermatosis of pregnancy?

A

1- atopic eruption of pregnancy
2- pemphigoid gestationis
3- polymorphic eruption of pregnancy
4- Intrahepatic cholestasis

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2
Q

Among physiological skin changes in pregnancy, what is the most common change?

A

Melasma , 75 % of pregnant women
Often in 2nd&3rd trimester.
πŸ“Œ all treatments of melasma ( hydroquinone, retinol, laser …) are contraindicated in pregnancy.
πŸ“Œ in pregnancy: just sunblock.

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3
Q

What is the main cause of stariae gravidarum? What are the risk factors?

A

πŸ“Œ Rupture of dermal elastic fibers
[ changes in the connective tissues ]
πŸ“Œ Risk factors: family histor, dark skinned women, excessive abdominal distention.

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4
Q

What is the treatment of striae gravidarum?

A

Emollients
No evidence that vit E or tea tree oil have any special value.

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5
Q

What is the incidence of spider naevi in pregnancy as a physiological change ? When they appear?

A

66 % in caucasians
11 % in black
🚩face ,neck , hands, arms
🚩in the 2nd trimester, usually disappear around 3rd month postnatally.
🚩 treatment: sclerotherapy , laser

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6
Q

Acute telogen effluvium, when it happens?, when the recovery?

A

3 - 6 months postpartum
Recovery: within 9- 12 months

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7
Q

What is the percentage of pregnant women affected by pruritus in the absence of any biochemical disorder? What is the recurrence rate?

A

Incidence: 18 %
Recurrence in subsequent pregnancies: 80 %

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8
Q

How to take a history from a pregnant woman with pruritus?

A

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.

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9
Q

What is the most common dermatosis of pregnancy?

A

Atopic eruption 1 / 300
Other terminology of this :
(Prurigo gestationis - pruritic folliculitis - eczema of pregnancy)

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10
Q

What are the risk factors of atopic eruption in pregnancy? What is the parthogenesis?

A

family history of atopy
80 % πŸ‘‰ primary condition
20% πŸ‘‰ exacerbation of preexisting condition
πŸ“Œ pathogenesis : pregnancy specific immunological changes

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11
Q

How atopic eruption of pregnancy presented?

A

2nd or 3rd trimester ( can occur earlier)
Erythematous, excoriated Nodules or papules on the face, neck, chest, extensor surfaces of the limbs

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12
Q

How is atopic eruption of pregnancy diagnosed?

A

Clinically- no other investigations needed
Histopathology : non specific
Immunofluorescence: negative

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13
Q

When does atopic eruption of pregnancy improve?

A

After delivery
No postpartum exacerbation
No data about recurrence

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14
Q

What are the treatment options for atopic eruption of pregnancy?

A

Symptomatic: oatmeal bath - topical antipruritic: 1% menthol- calamine
Topical steroids- oral antihistamine- ultraviolet light to help alleviate symptoms
πŸ“Œ cool environment is recommended
πŸ“Œ topical benzoyl peroxide/ erythromycin with zinc acetate lotion are sometimes effective

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15
Q

What is the incidence of polymorphic eruption of pregnancy?

A

1/ 160 - 1/ 300 of pregnancies

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16
Q

How is polymorphic eruption of pregnancy ( PUPPP) presents?

A

πŸ”΄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

17
Q

What are the risk factors for polymorphic eruption of pregnancy (PUPPP) ?

A

Nulliparity - multiple pregnancies
Any other cause of over distension of the abdominal skin

18
Q

How is PUPPP diagnosed?

A

Clinically
πŸ€Biopsy ONLY: if no response to intial treatment or there is a doubt in the diagnosis
πŸ€ immunofluorescence: ( direct/indirect) : NEGATIVE [ help in DD with pemphigoid gestationis]

19
Q

What is the first line treatment for polymorphic eruption of pregnancy ( PUPPP)?

A

1-TOPICAL STEROIDS
Oral steroids are virtually never required
2- antihistamines / emollients

20
Q

What is the recurrence rate of PUPPP?

21
Q

What is the impact of PUPPP on maternal & fetal outcomes?

A

NOOO impact

22
Q

When does pemphigoid gestationis ( herpes gestationis) occur?

A

After 2nd & 3rd trimester,
& rarely after delivery

23
Q

What is the incidence rate of pemphigoid gestationis?

A

1/1700 - 1/ 50,000

24
Q

How does pemphigoid gestationis appear ?

A

1-Urticarial papules &plaques: around the umbilicus extending to extremities, palms & soles
With MUCOSAL SPARING
2- Blisters; around the edge of the rash

25
Q

What is the cause behind pemphigoid gestationis?

A

It’s believed that autoimmune condition with antibodies against target antigen ( proteins of placenta & skin)
** corelation with HAlA type DR3-DR4

26
Q

How is pemphigoid gestationis diagnosed?

A

SKIN BIOPSY is necessary
2 samples : from perilessional skin
1 for histology
1 for immunofluorescence

27
Q

What is the treatment of pemphigoid gestationis?

A

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

28
Q

Why is CYCLOSPORINE considered safe in pregnancy & contraindicated in breastfeeding?

A

Owing to the potential for immunosuppression & neutropenia

29
Q

What is the course of pemphigoid gestationis in pregnancy?

A

Exacerbations & remissions are characteristic
πŸ“Œ flare up at delivery 75% of patients
πŸ“Œ flare up postpartum: common

30
Q

When does pemphigoid gestationis resolve?

A

2-6 weeks postpartum

31
Q

What is the recurrence of pemphigoid gestationis?

A

There is a recurrence in subsequent pregnancies with earlier onset & increasing severity
πŸ€ Also with: OC or during MENSTRUATION

32
Q

What are the fetal outcomes in a pregnancy complicated by pemphigoid gestationis?

A

1- IUGR πŸ‘‰ monthly scan
2- preterm delivery: conflicting evidence
3- 1/10 babies will devlop SKIN LESIONS due to passive transfer of antibodies

33
Q

What is the autoimmune disease that associated with pemphigoid gestationis?

A

GRAVES DISEASE
πŸ‘‰πŸ‘‰ consider TFTs

34
Q

When to refer a pregnant with skin eruption to obstetric consultant?

A

1- pemphigoid gestationis
2- Intrahepatic cholestasis

35
Q

When to refer a pregnant with a skin eruption to a dermatologist?

A

1-Any skin eruption where initial management fails or associated with systemic symptoms
2- pemphigoid gestationis