Skin Eruptions specific to pregnancy: an overview TOG 2013

Question 1

How common is melasma?

Answer 1

75%
Most common 2nd/3rd trimester
a can persist months/years postpartum

Question 2

How to prevent development and exacerbation of melasma?

Answer 2

Avoid excessive sunlight, broad spectrum sunscreens

Question 3

Risk factors for striae gravid arum

Answer 3

Personal Hx
Fhx
Dark skinned
Excessive abdo distention

Question 4

Prevent of stretch marks

Answer 4

Emollients

Question 5

Prevalence of spider naevi in caucasians and black people in pregnancy?

Answer 5

Caucasians: 66%
Black: 11%

Appear 2nd trimester, most disappear by 3rd post natal moth

Question 6

Hair changes in pregnancy

Answer 6

Increased hair growth AN
Acute telogen effluvium - hair shedding, 3-6 months PP, recovery 9-12 months

Question 7

Pruritis in pregnancy

Answer 7

18%

Question 8

What is the incidence of atopic eruption of pregnancy?

Answer 8

1 in 300

Question 9

Timing of onset of tropic eruption of pregnancy?

Answer 9

75% before 3rd trimester
Mostly multiparous women

Question 10

Distribution of atopic eruption of pregnancy

Answer 10

Eczeamtous changes, typical atopic sites (face, neck, flexural surface of limbs) or papular lesions on trunk/limbs

Question 11

Resolution of atopic eruption of pregnancy

Answer 11

Approves after delivery, may persist for several months

Question 12

Fetal considerations for atopic eruption of pregnancy

Answer 12

No impact to foetus

Question 13

Treatment for atopic eruption of pregnancy

Answer 13

Emollients
Topical steroids
Antihistamines

Question 14

Incidence polymorphic eruption of pregnancy

Answer 14

1/200
0.5%

Question 15

Timing of onset polymorphic eruption of pregnancy

Answer 15

3rd trimester, mean 34 weeks
More common in primps

Question 16

Distribution of polymorphic eruption of pregnancy

Answer 16

pruritic, erythematous papules commonly located within the abdominal striae and with periumbilical sparing. It progresses to the trunk and extremities, sparing the palms and soles in the majority of cases, and does not affect the face.

The lesions can coalesce to form plaques or wheals, often resembling target lesions.

Question 17

Timing of resolution

Answer 17

Mostly 4-6 weeks after onset

Question 18

Treatment polymorphic eruption of pregnancy

Answer 18

Methonal 1% aqueous cream
Hydrocostisone ointment 1% antihistamine - chlorphenamine/promethzine/loratadine, cetirizine
Rarely systemic steroids

Question 19

Incidence of pemphigoid gestationis

Answer 19

Rare 1/10,000-60,000

Question 20

Distribution pemphigoid gestationis

Answer 20

Abdomen, umbilicus effectes, lesion being in periumbilical region, spread to limbs, palms and soles
Intensly pruritic, urticated erythamtous papule and plaques, target lesions - after 2 weeks vesicles, tense bullae

Question 21

Resolution

Answer 21

If occurs 2nd trimester, often improvement at end of pregnancy but PP flare. Can persist for several month

Question 22

Pathogenesis pemphigoid gestationis

Answer 22

Autoimmunes
associated bullous pemphigoid
Ass other autoimmune conditions

Question 23

Fetal considerations pemphigoid gestationis

Answer 23

Increased risk low birthweight, preterm delivery, stillbith
10% bulbous eruption

Question 24

Treatment pemphigoid gestationis

Answer 24

Potent topical corticosteroids
Most require systemic steroids pred 4-60mg/day
Some topical or systemic immunuosuprresion - cyclosporin/tacrolimus
Antihistamines