Pregnancy Dermatoses

Published on 05/03/2015 by admin

Last modified 05/03/2015

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Pregnancy Dermatoses

There are several dermatoses that occur during pregnancy or immediately postpartum, in particular polymorphic eruption of pregnancy, pemphigoid gestationis, and atopic eruption of pregnancy. Pruritus due to intrahepatic cholestasis of pregnancy leads to nonspecific skin lesions, including excoriations due to scratching. Impetigo herpetiformis simply represents pustular psoriasis occurring during pregnancy, and this may be related to the relative hypocalcemia of pregnancy. Lastly, there are physiologic changes that occur during pregnancy.

Polymorphic Eruption of Pregnancy (PEP; Pruritic Urticarial Papules and Plaques of Pregnancy [PUPPP])

• Relatively common disorder (~1 in 160 deliveries) that begins late in the third trimester or during the immediate postpartum period; occurs primarily in primiparous women, with an increased frequency in those with multigestational pregnancies.

• Pruritic edematous papules and plaques, whose color varies from pink to red-brown depending on skin phototype, that often involve the abdominal striae but spare the umbilicus (Fig. 22.1); polymorphic presentation includes patches of erythema, targetoid lesions, tiny vesicles, and eczematous plaques (Fig. 22.2).

Fig. 22.1 Polymorphic eruption of pregnancy. The edematous urticarial lesions favor the striae (A, C) and the upper thighs (B, D) and spare the umbilicus. Note the pink color in a woman with skin phototype II versus the red-brown color in a more darkly pigmented patient.

Fig. 22.2 Polymorphic eruption of pregnancy. The clinical spectrum includes: (A) macular erythema, which can be widespread; (B) targetoid lesions; and (C) tiny vesicles due to marked epidermal spongiosis or dermal edema. Courtesy, Christina M. Ambros-Rudolph, MD.

• Lesions can become widespread, but usually spare the face, palms, and soles; the eruption spontaneously resolves within 4–6 weeks after delivery.

• In general, does not recur with subsequent pregnancies, in contrast to pemphigoid gestationis (PG), and there is no fetal risk.

• DDx: PG (may require direct immunofluorescence [DIF] of perilesional skin to distinguish), urticarial drug eruption, viral exanthem, allergic contact dermatitis, scabies, erythema multiforme minor.

• Rx: topical CS and oral antihistamines usually suffice (see Appendix); occasionally, severe cases require oral CS (prednisolone preferred during pregnancy because of significant inactivation by placenta, leading to a mother : fetus ratio of 10 : 1).