pregnancy-specific dermatology disorder

8/11/2019 Pregnancy-Specific Dermatology Disorder

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Pregnancy-Specific Dermatology

Disorder

Ahmad Zeiree Bin Abdullah


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About

Pruritic urticarial papules and plaques of

pregnancy (PUPPP)

Prurigo of pregnancy

Intrahepatic cholestasis of pregnancy

Pemphigoid gestationis

Impetigo Herpetiformis Pruritic folliculitis in pregnancy


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PUPPP

most common

1:300

Common in 1st

pregnancy and multiplegestation

etiology remains unclear

Skin stretching may play a role in inciting animmune mediated reaction


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Intensely pruriticurticarial plaques andpapules with or withouterythematous patchesof papules and vesicles

rash first appears onabdomen, often alongstriae and occasionallyinvolves extremities

face usually is notaffected


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Management of PUPPP

No specific treatment

Antihistamin and topical steroidpruritus

If severe,consider systemic corticosteroid Usually resolves after 2 weeks of delivery.


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Prurigo of pregnancy

All trimester

Not uncommon

prolonged course of prurigo Cause is unclear

a/w intrahepatic cholestasis of pregnancy and

history of atopic


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Sign:

- Erythematous papules

and nodules on the

extensor surfaces of theextremities

Management:

Symtomatic relief

mid-potency topical steroid

and oral a.histamine


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Intrahepatic cholestasis of pregnancy

severe pruritus in the third trimester (pruritusgravidarum)

Diagnosis based on:

clinical history:pruritus with or w/o jaundice

Presentation: no primary skin lesion

laboratory of cholestasis marker:elevated serum bile acid levels

elevated alkaline phosphatase

with or w/o elevated bilirubin

If severecoagulopathy and vit K deficiency


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Etiologyunclear

Family history (+)

a/w with the presence of HLA-A31 and HLA-B8

Recur in subsequent pregnancy

High risk of preterm delivery, meconiumstained amniotic fluid and intrauterinedemise.

Treatment:Oral antihistamines for mildpruritus; ursodeoxycholic acid (ursodiol[Actigall]) for more severe cases


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Pemphigoid gestationis

Herpes gestationis

1:50000 mid-late pregnancies

HLA-DR3 and HLA-DR4

Increse risk of other autoimune disease (grave)


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Pruritic papules,plaques, and vesiclesevolving intogeneralized vesicles orbullae

Initial periumbilicallesions may generalize,although the face,scalp, and mucousmembranes usually arenot affected


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Immunodiagnostic study

-deposit of complement 3 along dermoepidermal junction

-imunoglobulin G autoantibodies cross placenta and resulting5-10% newborns develop urticaria and vesicular bulbar

lesion.Risk for fetal

-perterm delivery

-newborn with SGA

Management: Antihistamin and topical steroid

If severe,consider systemic corticosteroid


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Impetigo herpetiformis

-pustular psoriasis

-rare skin disorder

-2ndtrimester of pregnancy


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Round, arched, or polycyclicpatches covered with smallpainful pustules in a

herpetiform pattern most commonly appears on

thighs and groin, but rash maycoalesce and spread to trunkand extremities

face, hands, and feet are notaffected

mucous membranes may beinvolved


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Systemic signs and symptoms of impetigo

herpetiformis include nausea, vomiting, diarrhea,

fever, chills, and lymphadenopathy. Pruritus

generally is absent. Medical complications (e.g., secondary infection,

septicemia, hyperparathyroidism with

hypocalcemia, hypoalbuminemia) may occur.


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Treatment:

-systemic corticosteroids and antibiotics to treatsecondarily infected lesions. Prednisone, 15 to 30 mg

to as high as 50 to 60 mg per day followed by a slow

taper, may be necessary.

The disease typically resolves after delivery, although it

may recur during subsequent pregnancies.


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PRURITIC FOLLICULITIS OF

PREGNANCY


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PRURITIC FOLLICULITIS OF

PREGNANCY

second and third trimesters

presents as erythematous follicular papules and sterilepustules

Spontaneous resolution occurs after delivery.

This condition likely is underreported because it oftenis misdiagnosed as bacterial folliculitis.

The etiology of pruritic folliculitis of pregnancy isuncertain

Treatments include topical corticosteroids, topicalbenzoyl peroxide (Benzac), and ultraviolet B lighttherapy.

pregnancy-specific dermatology disorder

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