Chapter 28 - Pregnancy Dermatoses Flashcards Preview

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Flashcards in Chapter 28 - Pregnancy Dermatoses Deck (27):
1

True or false: there's an increased risk for prematurity and small-for-gestational-age births in mothers with pemphigoid gestationis.

True

2

What is the autoantibody in pemphigoid gestationis?

BP180

3

What HLA types are associated with gestational pemphigoid?

HLA DR3 and DR4

4

When during pregnancy does gestational pemphigoid present?

Classically during late pregnancy, but it can also present post-partum

5

Can newborns be affected by gestational pemphigoid?

Yes; up to 10% develop blistering, but the disease tends to be mild and self-limited

6

True or false: systemic steroids can cause placental calcification and small-for-gestional-age babies.

True

7

What type of patient is most at risk for PUPPP?

Primiparous women who experience rapid and excessive weight gain during pregnancy

8

Where on the body do the lesions of PUPPP typically begin?

On the abdomen, within abdominal striae

9

True or false: in biopsies of skin affected by PUPPP, there is usually a linear band of C3 along the basement membrane zone on DIF.

False; in PUPPP the DIF is negative; in gestational pemphigoid there will be a linear band of C3 along the basement membrane zone

10

True or false: like in PUPPP, the primary lesions of cholestasis of pregnancy are urticarial papules.

False; there are no primary lesions in cholestasis of pregnancy

11

What risk is there to newborns born to mothers with cholestasis of pregnancy?

Increased risk of meconium staining and fetal distress

12

True or false: viral hepatitis is more common during pregnancy than cholestasis of pregnancy, and must be excluded.

True

13

What are the 4 pruritic entities of pregnancy?

1) Pemphigoid gestationis, 2) pruritic urticarial papules & plaques of pregnancy (PUPP), 3) prurigo of pregnancy, 4) cholestasis of pregnancy

14

At which trimester does pemphigoid gestationis present?

T3, immediate postpartum

15

What is the pathogenesis of PG?

Anti-BMZ factor (herpes gestationis factor, anti-BPAG2/collagen XVII Ab) that causes C3 deposition along DEJ

16

What are the possible neonatal complications with PG?

Prematurity, SGA, bullous lesions at birth, no effect on morbidity/mortality. Mothers are at risk of subsequently developing Graves disease, but have no other risks!

17

What defines cholestasis of pregnancy? Hint: there are 5 criteria

1) generalized pruritus with no hx of viral hepatitis or hepatotoxic drugs, 2) no primary lesions, 3) biochemical findings consistent with cholestasis, 4) resolves after pregnancy, 5) recurrence with subsequent pregnancies

18

What is the % of recurrence with subsequent pregnancies in cholestasis of pregnancy?

60-70%

19

What is the treatment for cholestasis of pregnancy?

Cholestyramine, phenobarbital, UVB, rest, low fat diet, ursodeoxycholic acid (15mg/kg/d)

20

What are some physiologic changes during pregnancy?

Hyperpigmentation, melasma, hirsutism, telogen effluvium, androgenetic alopecia, subungual hyperkeratosis, onycholysis, nail grooving/brittleness, increased sweating/sebum, striae, spider angiomas, palmar erythema, non-pitting edema, varicosities, vasomotor instabiliy, purpura, gingival hyperemia/hyperplasia, pyogenic granuloma, hemorrhoids

21

When does the dermatitis flare in autoimmune progesterone dermatitis?

Luteal phase

22

What is the treatment for PG?

Prednisone 0.5mg/kg PO daily (S/E: placental calcifications, low birth weight), Class II or lower topical steroid, cyclosporine

23

What is the most common pregnancy-specific dermatoses?

PUPPP (pruritic urticarial papules & plaques of pregnancy)

24

How do you diagnosis PUPPP?

Diagnosis of exclusion. Rule out urticarial pemphigoid gestationis although do not suggest IF/ELISA testing in classic cases of PUPPP

25

True/False: PUPPP can be associated with maternal or fetal morbidity.

False

26

What is prurigo of pregnancy also known as?

snier's prurigo gestationis, Nurse's early onset prurigo of pregnancy, Spangler's papular dermatitis of pregnancy, pruritic folliculitis, linear IgM disease of pregnancy

27

What is the 1st and 2nd most common cause of gestational jaundice?

Viral hepatitis, cholestasis of pregnancy