8/11/2019 Pregnancy-Specific Dermatology Disorder
1/18
Pregnancy-Specific Dermatology
Disorder
Ahmad Zeiree Bin Abdullah
8/11/2019 Pregnancy-Specific Dermatology Disorder
2/18
About
Pruritic urticarial papules and plaques of
pregnancy (PUPPP)
Prurigo of pregnancy
Intrahepatic cholestasis of pregnancy
Pemphigoid gestationis
Impetigo Herpetiformis Pruritic folliculitis in pregnancy
8/11/2019 Pregnancy-Specific Dermatology Disorder
3/18
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
8/11/2019 Pregnancy-Specific Dermatology Disorder
4/18
Intensely pruriticurticarial plaques andpapules with or withouterythematous patchesof papules and vesicles
rash first appears onabdomen, often alongstriae and occasionallyinvolves extremities
face usually is notaffected
8/11/2019 Pregnancy-Specific Dermatology Disorder
5/18
Management of PUPPP
No specific treatment
Antihistamin and topical steroidpruritus
If severe,consider systemic corticosteroid Usually resolves after 2 weeks of delivery.
8/11/2019 Pregnancy-Specific Dermatology Disorder
6/18
Prurigo of pregnancy
All trimester
Not uncommon
prolonged course of prurigo Cause is unclear
a/w intrahepatic cholestasis of pregnancy and
history of atopic
8/11/2019 Pregnancy-Specific Dermatology Disorder
7/18
Sign:
- Erythematous papules
and nodules on the
extensor surfaces of theextremities
Management:
Symtomatic relief
mid-potency topical steroid
and oral a.histamine
8/11/2019 Pregnancy-Specific Dermatology Disorder
8/18
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
8/11/2019 Pregnancy-Specific Dermatology Disorder
9/18
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
8/11/2019 Pregnancy-Specific Dermatology Disorder
10/18
Pemphigoid gestationis
Herpes gestationis
1:50000 mid-late pregnancies
HLA-DR3 and HLA-DR4
Increse risk of other autoimune disease (grave)
8/11/2019 Pregnancy-Specific Dermatology Disorder
11/18
Pruritic papules,plaques, and vesiclesevolving intogeneralized vesicles orbullae
Initial periumbilicallesions may generalize,although the face,scalp, and mucousmembranes usually arenot affected
8/11/2019 Pregnancy-Specific Dermatology Disorder
12/18
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
8/11/2019 Pregnancy-Specific Dermatology Disorder
13/18
Impetigo herpetiformis
-pustular psoriasis
-rare skin disorder
-2ndtrimester of pregnancy
8/11/2019 Pregnancy-Specific Dermatology Disorder
14/18
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
8/11/2019 Pregnancy-Specific Dermatology Disorder
15/18
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.
8/11/2019 Pregnancy-Specific Dermatology Disorder
16/18
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.
8/11/2019 Pregnancy-Specific Dermatology Disorder
17/18
PRURITIC FOLLICULITIS OF
PREGNANCY
8/11/2019 Pregnancy-Specific Dermatology Disorder
18/18
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.
Top Related