Pruritic urticarial papules and plaques of pregnancy. Although the dermatoses of pregnancy are believed to be a direct result of gestation or the products of conception, they are classified as pathologic processes 4. Sep 10, 2012 some aspects regarding the etiology and the nosologic classification of various pregnancy dermatoses are highly controversial. Intrahepatic cholestasis of pregnancy icp, also known as obstetric cholestasis, cholestasis of pregnancy, jaundice of pregnancy, pruritusprurigo gravidarum is a reversible form of hormonally triggered cholestasis that typically develops in genetically predisposed inditable 1. The most recent reclassification of dermatoses of pregnancy includes polymorphic eruption of pregnancy, atopic eruption of pregnancy, and pemphigoid gestationis. The effect of pregnancy on preexisting skin diseases and safe treatment options for usage during pregnancy will be provided. Introduction pregnancy is a physiological state leading to changes of skin and appendages which may. Specific dermatoses of pregnancy and their treatment. Happens only in pregnancy risk for the mother and the fetus a distinction between dermatological diseases that happen to occur while the patient is pregnant versus specific dermatoses of pregnancy. Dermatoses of pregnancy may be physiological changes, preexisting changes or those specific to the pregnancy. Skin conditions called dermatoses of pregnancy are a group of itchy or inflammatory skin disorders that can occur while a woman is pregnant. The specific dermatoses of pregnancy are a rare group of severely pruritic inflammatory skin diseases related specifically to pregnancy andor the immediate postpartum period. Evaluate a pregnant woman with cutaneous lesions and diagnose the major dermatoses specific to pregnancy puppp, pemphigoid.
Chi cc, kirtschig g, aberer w, gabbud jp, lipozencic j, karpati s, et al. The other seven patients showed the features of herpes gestationis. This presentation highlights the pregnancy specif slideshare uses cookies to improve functionality and performance, and to. Most of these dermatoses resolve once the baby is born or slightly thereafter. Nov 23, 2015 dermatoses of pregnancy may be physiological changes, preexisting changes or those specific to the pregnancy. Pregnancy is also known to influence the course of preexisting skin diseases in both positive and negative ways2. Their 2year prospective study was based on 200 patients from their specialist clinic for pregnancy dermatoses.
Learning objectives identify normal physiologic cutaneous changes that are observed during pregnancy identify the most common dermatoses that occur during pregnancy and their associated maternalfetal risks understand a basic systemic approach to pruritus in pregnant women and develop confidence in treating. Data regarding specific dermatoses of pregnancy in our community are insufficient. Abstract the dermatoses of pregnancy represent a distinct heterogenous group of cutaneous disorders that can impact the health of the pregnant woman and potentially the fetus. The highest number of cases presented with coincidental or. Pregnancy specific skin dermatoses include an illdefined heterogeneous group of pruritic skin eruptions which are seen only in pregnancy. While some authors highlight the existence of premises allowing several skin disorders to be regrouped within broader disease concepts, others underline the absence of clear, undisputed etiopathogenetic data that could support. Dermatoses of pregnancy clues to diagnosis, fetal risk and. The specific dermatoses of pregnancy represent a diverse group of intensely pruritic dermatoses, occurring only in the puerperal state. Atopic eruption of pregnancy is the most common of these. Objectives list the dermatoses of pregnancy compare and contrast the clinical presentations of the different pregnancy dermatoses identify the treatment options for each. The dermatoses of pregnancy can be classified into the following 3 groups. Some aspects regarding the etiology and the nosologic classification of various pregnancy dermatoses are highly controversial. Aug 06, 2011 pruritus is the leading symptom of the specific dermatoses of pregnancy, but may also be associated with dermatoses that coincide by chance with pregnancy e.
This presentation highlights the pregnancy specif slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Besniers prurigo, prurigo gestationis, nurses early onset prurigo of pregnancy it is the most common pregnancy specific dermatoses that includes eczematous or papular lesions in females with personal or family history of atopy and elevated ige accounting for nearly half of all patients. A dermatosis of pregnancy cleveland clinic journal of medicine. Evidencebased s3 guideline on topical corticosteroids in pregnancy. Eight women had a bullous skin disease that occurred during pregnancy. A prospective study was performed at dermatology outpatient. While many physicians are familiar with the normal physiologic changes in pregnancy, knowledge on the rarer pregnancy specific dermatoses is oftentimes lacking. Dermatoses unique to pregnancy are important to recognize for the clinician as they carry considerable morbidity for pregnant mothers and in some instances constitute a risk to the fetus. These include the following conditions, which are discussed below 26. Those who care for pregnant women are left to try to differentiate these conditions. The specific dermatoses of pregnancy represent a heterogeneous group of pruritic skin diseases that have been recently reclassified and include pemphigoid herpes gestationis, polymorphic eruption of pregnancy syn.
The diagnosis was made on predefined clinical criteria, supported by histopathological and direct immunofluorescence studies of the skin when appropriate. Skin changes in pregnancy can be broadly divided into physiological box 1,1 specific dermatoses of pregnancy, and other common skin diseases in pregnancy. The dermatoses of pregnancy sachdeva s indian j dermatol. It is therefore important for the clinicians to recognize and treat these cutaneous disorders to minimize maternal and fetal morbidity. Intrahepatic cholestasis of pregnancy, pemphigoid ges tationis, polymorphic eruption of pregnancy. Polymorphic eruption of pregnancy pep pruritic urticarial papules and plaques of pregnancy pupp most common pregnancy dermatosis 1 in 160 pregnancies 75% occur late in 3rd trimester 3639 weeks 57. The first classification of dermatoses of pregnancy was proposed by holmes and black in 1983 and included four skin conditions. Current study was designed to assess the frequency of specific dermatoses of pregnancy in a tertiary care. Polymorphic eruption of pregnancy pruritic urticarial papules and plaques of pregnancy. Dermatoses of pregnancy clues to diagnosis, fetal risk. A dermatosis of pregnancy on the eighth day after giving birth to monochorionic twins, a 33yearold woman presented with pruritic erythematous papules and plaques that started on the striae of the lower abdomen and spread rapidly to the thighs and upper limbs, sparing the umbilical region figure 1. Pdf pregnancy is frequently associated with major skin changes. Another dermatosis, pustular psoriasis of pregnancy, could be included for similar reasons. While some authors highlight the existence of premises allowing several skin disorders to be regrouped within broader disease concepts, others underline the absence of clear, undisputed etiopathogenetic data that could support such classifications.
The ability to distinguish between dermatoses of pregnancy is of utmost importance, as some intrahepatic cholestasis of pregnancy and pemphigoid gestationis can cause morbidity and mortality of mother and fetus, such as intrauterine growth restriction, preterm delivery and stillbirth. Dermatoses of pregnancy sasseville 1981 international. Hormonal changes in pregnancy may result in physiological alterations in the skin, hair and nails. Atopic eruption of pregnancy is the most common pregnancy specific dermatoses followed by polymorphic eruption of pregnancy. Dr amanda oakley, dermatologist, hamilton, new zealand, 2009. Pregnancy dermatoses describe a set of extremely pruritic dermatologic disorders that uniquely present in the gestational period. While some use the term polymorphic eruption of pregnancy to cover these, this term is a synonym used in the uk for pruritic urticarial papules and plaques of pregnancy, which is the commonest of these skin conditions. Each dermatosis has its own specific characteristics, treatments, and risks. Pregnancy may result in an increase in prevalence or severity of some common and uncommon skin problems. One patient had clinical, histopathologic, and immunopathologic features of pemphigus. The patients with pregnancy specific dermatoses were followed up till delivery and the pregnancy outcome was recorded. Polymorphic eruption of pregnancyalso known as pruritic urticarial papules and plaques of pregnancy 1 is a specific dermatosis of pregnancy characterized by pruritic urticarial papules on abdominal striae that usually first appear during the latter portion of the third trimester or immediately postpartum. Aa 1938 00 iournal of the american academy of dermatology volume 6 number 6 june, 1982 iii iiii iii ii i ii continuing medical education dermatoses of pregnancy george b.
Changes in the skin during pregnancy may be divided into physiological changes and pregnancy specific dermatoses. While many physicians are familiar with the normal physiologic changes in pregnancy, knowledge on the rarer pregnancyspecific dermatoses is oftentimes lacking. The skin changes in pregnancy can be either physiological hormonal, changes in preexisting skin diseases or development of new pregnancy specific dermatoses. The relative rarity of these conditions, the often variable clinical appearance, and the lack of definitive diagnostic tests have led to confusion regarding the appropriate diagnosis and management of the specific dermatoses of pregnancy. Correct diagnosis and classification are essential for the treatment of these disorders, when necessary. The relative rarity of these conditions, the often variable clinical appearance, and the lack of definitive diagnostic tests have led to confusion regarding the appropriate diagnosis and management of the. Pruritic urticarial papules and plaques of pregnancy wholly abated with one week twice daily application of fluticasone propionate lotion. This may lead to misdiagnosis and mistreatment of the patients. Changes in the skin during pregnancy may be divided into physiological changes and pregnancyspecific dermatoses. History of pregnancy dermatoses 1872 milton described herpes gestationis 1904 besnier coined term prurigo gestationis for all dermatoses other than pemphigoid gestationis 1941 costello changed term to prurigo gestationis of besnier. Mean age was 32 years, 62% was multigravidae and 54% of pregnancy dermatoses occurred during third trimester.
Dermatoses of pregnancy polymorphic eruption of pregnancyalso known as pruritic urticarial papules and plaques of pregnancy1is a specifi c dermatosis of pregnancy characterized by pruritic urticarial papules on abdominal striae that usually fi rst appear during the latter portion of the third trimester or immediately postpartum. Another dermatosis, pustular psoriasis of pregnancy, could be included for. Pregnancy dermatoses nathan w rojek, md assistant professor of dermatology uc irvine school of medicine. The specific dermatoses of pregnancy represent a heteroge neous group of severely pruritic inflammatory dermatoses associated exclusively. The current classification of pregnancyspecific cutaneous disorders is. Dermatosis definition of dermatosis by medical dictionary. Plan the fetal follow up required for gestational pemphigoid and advise the patient about. These diseases include pemphigoid gestationis, polymorphic eruption of pregnancy, intrahepatic cholestasis of pregnancy, and atopic eruption of pregnancy. Pruritic urticarial papules and plaques of pregnancy in twin and triplet pregnancies. The dermatoses of pregnancy represent a distinct heterogenous group of cutaneous disorders that can impact the health of the pregnant woman and potentially the fetus. The first classification of dermatoses of pregnancy was proposed by holmes and black 1 in 1983 and included four skin conditions. Pregnancyspecific skin dermatoses include an illdefined heterogeneous group of pruritic skin eruptions which are seen only in pregnancy. The dermatoses of pregnancy are a heterogeneous group of pruritic inflammatory dermatoses that occur exclusively during pregnancy andor in the immediate postpartum period 1.
List the dermatoses of pregnancy compare and contrast the clinical presentations of the different pregnancy dermatoses identify the treatment options for each specific condition recognize which pregnancy dermatoses confer a risk to the fetus. During pregnancy immunologic endocrine metabolic and vascular changes occur that make the pregnant woman susceptible to skin changes both physiologic and pathologic. These include atopic eruption of pregnancy, polymorphic eruption of pregnancy, pemphigoid gestationis and intrahepatic cholestasis of pregnancy. The main diseases under this heading include pruritic urticarial papules and plaques of pregnancy, pemphigoid gestationis. Dermatoses of pregnancy are the inflammatory skin diseases that are specific to women while they are pregnant. Specific dermatoses of pregnancy, prurigo of pregnancy, pruritic folliculitis of pregnancy, herpes gestationis, polymorphic eruption of pregnancy. Atopic eruption of pregnancy, dermatoses of pregnancy. In a second step, the four specific dermatoses of pregnancy need to be discriminated. Physiologic skin changes in pregnancy include changes in pigmentation, alterations of the connective tissue, vascular system, and endocrine function as well as changes in hair and nails table 11.
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