This document discusses several types of skin conditions that can occur during pregnancy including Pemphigoid Gestationis, Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP), Polymorphic Eruption of Pregnancy (PEP), and Prurigo of Pregnancy. It provides details on the clinical presentation, pathogenesis, diagnosis, and treatment options for each condition. The document emphasizes that most of these skin conditions do not pose risks to the fetus or mother, but may recur in subsequent pregnancies. Topical corticosteroids and oral antihistamines are usually first-line treatments.
4. Predominantly a disease of women in their 1st
pregnancy in the 3rd trimester
Pruritic urticarial papules ; microvesiculation, target
like, annular, polycyclic, no bullae
Begin on the abdomen (in the striae in 2/3 of the cases)
Usually sparing the periumbilical area, palms, soles, and
face
Recurrence in subsequent pregnancies, with menses or
with the use of oral contraceptives; uncommon
5. 10 times more common in women with
twins or triplets
Other : primiparous, male fetus, rapid or
excessive weight gain
Prognosis
unassociated with fetal or maternal morbidity and
mortality
6. Unknown
Sex hormones
Campbell et al; Progesterone has been shown to aggravate the
inflammatory process at the tissue level.
Im et al; increased progesterone receptor immunoreactivity in skin
lesions of PUPPP
Damage to connective tissue within the striae distensae
rapid abdominal wall distension → damage to connective tissue →
conversion of nonantigenic molecules to antigenic ones →
inflammatory process
Fetal cell migration to the maternal skin
Nelson et al ; Increased abdominal stretching → increased vascular
permeability → migration of chimeric cells into the maternal skin
7. Histopathology
Nonspecific perivascular lymphohistiocytic infiltrate
with some edema and eosinophils in the dermis
DIF; negative
Treatment
Conservative therapies
Topical emollients and topical corticosteroids
Oral antihistamines
Oral corticosteroids
8. Prurigo of pregnancy
Pruritic folliculitis of pregnancy
Atopic dermatitis or eczema of pregnancy
9. Prurigo gestationis
Papular dermatitis of pregnancy
Early onset prurigo of pregnancy
10. Clinical feautres
intensely pruritic rashes in the 2nd or 3rd trimester
small, mostly excoriated, nonvesicular erythematous
papules
grouped over the abdomen and the distal extensor
aspects of both upper and lower extremities
propensity to resolve leaving residual PIH
disappearance soon after delivery
Histopathologic examination; nonspecific
DIF; negative
11. No risk to the fetus or to the mother
Recurrences during subsequent pregnancies;
infrequent
Treatment
symptomatic
topical steroids
oral antihistamines
systemic steroids
12. Extremely itchy
erythematous follicular
papules, pustules localized
to the torso
≈ steroid induced acne
Any trimester
(m/c 2nd or 3rd )
May resolve before delivery
13. No morbidity to the mother or fetus
Biopsy; sterile folliculitis
DIF; negative
Treatment
Topical corticosteroid
Benzoyl peroxide
Emollient
UVB
14. Eczema of pregnancy
Eczematous lesion typically appear during the 1st and 2nd
trimester
All parts of the body including the face, palms and soles
Eczematous(50%), papular or prurigo-like features (30%)
15. Etiology: Unknown
20% exacerbation of atopic dermatitis
80% have no past history
Elevated serum IgE in app. 70% of patients
Treatment : topical steroid
16. Clinical features
Markedly pruritic and/or urticarial plaques, papules or
vesicles beginning in the periumbilical region before
spreading across the trunk and body, forming bullae
during the 2nd or 3rd trimester
sparing of the face, mucous membranes, palms, and
soles
17.
18. Pathology
subepidermal vesicles, spongiotic epidermis
some perivascular lymphocyte and histiocyte infiltrates
with a preponderance of eosinophils
DIF; C3 with or without IgG in a linear band along the
BMZ
19. Immunologic response against class II antigens of paternal
haplotype at the placenta, which then cross-reacts with the
skin
Associations with HLA DR3 (61%-80%), DR4 (52%), or
both (43%-50%)
Immunology
HG factor; IgG1 subclass
Epitope mapping; common antigenic site within the
noncollagenous domain (NC16A) of the transmembrane
180-kD HG Ag (BP Ag 2)
20. Clinical course
Remit before delivery or regresses spontaneously over
weeks or months after delivery
Flares
At the time of delivery
During menstruation
Oral contraceptives
Occurrences in subsequent pregnancies
earlier
more severe clinical picture
prolonged postpartum duration
21. No maternal risk
but an increased risk of Graves’ disease, other
autoimmune diseases
Mild increase in fetal morbidity or mortality
small-for-gestational-age infants
- associated with presence of blisters and disease onset
in 2nd trimester but not antibody titer or systemic
corticosteroid treatment
prematurity
22. Treatment
Early urticarial lesions
topical corticosteroids in addition to oral antihistamines
First line; (bullae)
systemic corticosteroids (0.5 mg/kg or 30mg/d of
prednisolone daily)
Chronic HG
plasmapheresis
박 등 (2000); Cyclosporine으로 호전을 보인 임신성 포진 1예
IVIG combined with cyclosporine
Refractory cases; adjuvant medications, especially in the
postpartum period (methotrexate, azothioprine,
gold,pyridoxine, cyclophosphamide)
Alternative ; dapsone, sulfapyridine, pyridoxine, cyclosporine
23. Classification
a rare form of generalized pustular psoriasis in
pregnancy
an entity distinct from psoriasis
Onset; most commonly in the 3rd trimester
Systemic symptoms; malaise, fever, delirium, diarrhea,
vomiting, tetany
Usually no personal or family history of psoriasis
Often associated with hypocalcemia or low serum levels of
vitamin D
24. Erythematous patches with grouped pustules at their
margins starting in the intertriginous or flexural areas and
extend centrifugally
25. Pustular psoriasis occurring during pregnancy tends to
worsen as the pregnancy progresses and resolves rapidly
at delivery or termination.
Obstetric complications
placental insufficiency; increased risk of stillbirths, fetal
abnormalities, neonatal death
fluid and electrolyte imbalance; increased morbidity
and mortality
26. Treatment
systemic corticosteroids; usually effective at a relatively low
dose of 15 to 30 mg/day of prednisone
oral cyclosporin (category C)
parenteral calcium with vitamin D
postpartum administration of oral retinoids
Recurrence in successive pregnancies
earlier onset and increased morbidity
increase in morbidity with each successive pregnancy
27.
28.
29. The safety of topical glucocorticoids (C) varies with the
strength of the agent and the specific vehicle employed.
high potency topical steroids used on large body surface areas
- increased potential for systemic absorption
Not more than 45g/week of potent or 100g /week of weak
or moderately potent topical corticosteroid should be
applied (without occlusion) if systemic absorption is to be
avoided.