Pocket ObGyn – Dermatologic Changes in Pregnancy
See Abbreviations
|
Disease |
Epidemiology |
Clinical characteristics
and physical exam |
Treatment |
| Chloasma
“Mask of Preg” |
50–75%
in Hispanics & those w/ dark complexions May fade w/i 1 y; persists in up to 30% |
Onset in 1st–2nd trimester hormone-assoc facial hyperpigmentation in malar or central distribution
Patchy macular facial hyperpigmentation Woods lamp |
Avoid sun Sunscreen Bleaching:
Hydroquinone, azelaic acid, tretinoin Chemical peel |
| Pruritic
Urticarial Papules and Plaques of Pregnancy (PUPPP) |
Most common gestational dermatosis
Up to 1/300 in Caucasian, multi gestations, nulliparas |
Onset in 3rd trimester. Typically resolves peripartum.
Lesions may be target-like, wheals, or vesicles Intensely pruritic. Urticarial papules & plaques w/i abdominal striae. Thighs, arms, buttocks may be affected. Face, palms, soles, periumbilical region usually spared. |
Symptom relief: Emollients, topical steroids, nonsedating antihistamine. Oral steroids for sev cases. |
| Impetigo herpetiformis
“Pustular Psoriasis of Preg” |
Rare, case reports only | Onset in 3rd trimester. Resolves slowly postpartum.
Complications: Constitutional sx, mat sepsis, & placental insufficiency. Nonpruritic sterile pustules surrounding erythematous plaques in flexures ® periph spread. Trunk, extremities, mucous membranes involved. Can become infected. Bx reveals spongiform pustule of Kogoj (neutrophil-containing pustule). |
Oral steroids Cyclosporine Abx if bact
superinfxn occurs Fetal surveillance |
| Herpes
gestationis |
1/10–50000
May occur w/ gestational trophoblastic dz. in Caucasian. >50% are HLADR3 or DR4+ |
Onset 2nd–3rd trimester Remits & recurs throughout
Preg.Worse in subseq pregnancies. Placental insufficiency risk. Extreme pruritis. Erythematous papules ® vesicles, bullae. Periumbilical ® trunk + extremities. Mucous membrane & facial sparing. Neonat lesions in 10%. Bx shows immunofluorescent C3 deposit at basement membrane (distinguishes from PUPPP) |
High potency topical steroids
Nonsedating antihistamine Often requires oral steroids Fetal surveillance Avoid oral contraceptive agents for 6 mo postpartum (can precipitate flare in up to 50%) |
|
Disease |
Epidemiology |
Clinical characteristics
and physical exam |
Treatment |
| Prurigo
gestationis |
Up to 1/300 | Onset 2nd–3rd trimester. Atopic eczema component. Resolves w/i 3 mo postpartum.
Pruritic papules or plaques on trunk & extensor surfaces of extremities. Excoriated; “insect bite” appearance. |
Emollients Topical steroids Nonsedating
antihistamine |
| Folliculitis | Rare | Onset 2nd–3rd trimester Poss atopic component.
Resolves w/i 2–3 w postpartum. Sterile papules or pustules arise from follicles on trunk. May spread to extremities. |
Topical steroids. Benzoyl peroxide.
Nonsedating antihistamine |
| From Am Fam Physician 2007;75:211; J Am Acad Dermatol 2006;54:395. | |||