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Flashcards in Dermatoses in Pregnancy Deck (22)
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1

What are the dermatoses in pregnancy?

  1. Pruritic urticarial papules and plaques of pregnancy (PUPPP)
  2. Pemphigoid gestationis (PG)
  3. Atopic eruption of pregnancy (AEP)
  4. Intrahepatic cholestasis of pregnancy (ICP)

2

General pruritus affects what % of pregnant women?

20%

3

What is this?

Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP). 

4

What is the most common pregnancy-specific dermatoses?

What is the most common dermatosis in pregnancy?

Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP). 

Atopic Eruption of pregnancy (AEP)

5

What is Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP) sometimes known as?

PEP (Polymorphic eruption of pregnancy)

6

When does PUPP/PEP occur?

Later part of the 3rd trimester or immmediately after deliver.

7

What pregnant women usually get it?

Primiparous or in multiple pregnancies.

8

How can you tell that it is PUPP/PEP?

There is peri-umbilical sparing.

9

What is the treatment for PUPP/PEP?

  • Topical steroids
  • Oral anti-histamines

10

How long does it take for PUPP/PEP to resolve with treatment?

It usually occurs 7-10 days after delivery.

11

In PEP/PUPP, is there any risk to the fetus?

No

12

What is this?

Why is it important to diagnose it?

Pemphigoid gestationis (PG)

  • Increased risk of low birth weight, pre-term birth etc.

13

What was pemphigoid gestationis (PG) previously known as?

Herpes Gestationis

14

What are the clinical features of Pemphigoid Gestationis (PG)?

  • Late pregnancy & time of delivery.
  • itchy urticarial lesion on the trunk.
  • Includes peri-umbilical area.
  • Rapid progression (unlike PUPP)
  • Tense Bullae.
  • Usually recurrs and worsens in subsequent pregnancies.

15

What is the treatment for Pemphigoid Gestationis (PG)?

Systemic corticosteroids 0.5mg per kg per day.

16

If doubt of the diagnosis for Pemphigoid Gestationis (PG), what should you do?

What would the investigation show?

Perilesional Punch biopsy for histology and direct IMF.

  • Histology -  subepidermal bulla with perivascular infiltrate and eosinophils.
  • IMF - linear C3 +/- IgG bands along BMZ of peri-lesional skin.

 

17

Does Pemphigoid Gestationis (PG) recurr?

Yes it usually recurrs and worsens with each pregnancy

It can also occur with menstruation and with COCP use.

18

What is this?

Atopic eruption of pregnancy (AEP)

19

How do you diagnose atopic eruption of pregnancy (AEP)?

  • Mostly clinically
  • Direct and indirect IMF - are negative
  • Bloods - elevated IgE and hyperesonsinophilia are found in 20-70% of cases.

20

What is the treatment for Atopic Eruption of the Skin (AES )?

  • Topical steroids
  • Emollients

21

What is  Intrahepatic cholestasis of pregnancy (ICP)?

  • Intrahepatic cholestasis of pregnancy is a rare liver condition which causes an itchy skin.
  • There is no rash but the skin may show scratch marks (excoriations) or become yellow (jaundiced).
  • This condition typically develops late in pregnancy.
  • Resolves within days after the baby is born

22

Desribe the algorithm for itch in pregnancy