Pregnancy-Specific Dermatology

Disorder
Ahmad Zeiree Bin Abdullah

About
Pruritic urticarial papules and plaques of
pregnancy (PUPPP)
Prurigo of pregnancy
Intrahepatic cholestasis of pregnancy
Pemphigoid gestationis
Impetigo Herpetiformis
Pruritic folliculitis in pregnancy
PUPPP
most common
1:300
Common in 1
st
pregnancy and multiple
gestation
etiology remains unclear
Skin stretching may play a role in inciting an
immune mediated reaction

Intensely pruritic
urticarial plaques and
papules with or without
erythematous patches
of papules and vesicles
rash first appears on
abdomen, often along
striae and occasionally
involves extremities
face usually is not
affected
Management of PUPPP
No specific treatment
Antihistamin and topical steroidpruritus
If severe,consider systemic corticosteroid
Usually resolves after 2 weeks of delivery.
Prurigo of pregnancy

All trimester
Not uncommonprolonged course of prurigo
Cause is unclear
a/w intrahepatic cholestasis of pregnancy and
history of atopic
Sign:
- Erythematous papules
and nodules on the
extensor surfaces of the
extremities
Management:
Symtomatic relief mid-
potency topical steroid
and oral a.histamine


Intrahepatic cholestasis of pregnancy
severe pruritus in the third trimester (pruritus
gravidarum)
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
Etiologyunclear
Family history (+)
a/w with the presence of HLA-A31 and HLA-B8
Recur in subsequent pregnancy
High risk of preterm delivery, meconium
stained amniotic fluid and intrauterine
demise.

Treatment:Oral antihistamines for mild
pruritus; ursodeoxycholic acid (ursodiol
[Actigall]) for more severe cases
Pemphigoid gestationis
Herpes gestationis
1:50000 mid-late pregnancies
HLA-DR3 and HLA-DR4
Increse risk of other autoimune disease (grave)
Pruritic papules,
plaques, and vesicles
evolving into
generalized vesicles or
bullae
Initial periumbilical
lesions may generalize,
although the face,
scalp, and mucous
membranes usually are
not affected
Immunodiagnostic study
-deposit of complement 3 along dermoepidermal junction
-imunoglobulin G autoantibodies cross placenta and resulting
5-10% 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


Impetigo herpetiformis
-pustular psoriasis
-rare skin disorder
-2
nd
trimester of pregnancy

Round, arched, or polycyclic
patches covered with small
painful pustules in a
herpetiform pattern
most commonly appears on
thighs and groin, but rash may
coalesce and spread to trunk
and extremities
face, hands, and feet are not
affected
mucous membranes may be
involved
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.


Treatment:
-systemic corticosteroids and antibiotics to treat
secondarily 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.

PRURITIC FOLLICULITIS OF
PREGNANCY
PRURITIC FOLLICULITIS OF
PREGNANCY
second and third trimesters
presents as erythematous follicular papules and sterile
pustules
Spontaneous resolution occurs after delivery.
This condition likely is underreported because it often
is misdiagnosed as bacterial folliculitis.
The etiology of pruritic folliculitis of pregnancy is
uncertain
Treatments include topical corticosteroids, topical
benzoyl peroxide (Benzac), and ultraviolet B light
therapy.