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AHN 548 Unit 3 > OB CH 30 Dermatological disorders in pregnancy > Flashcards

OB CH 30 Dermatological disorders in pregnancy Flashcards

1
Q

pathogenesis of hyperpigmentation during pregnancy

A

increased levels of melanocyte stimulating hormone, estrogen, and progesterone

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2
Q

pathogenesis of vascular changes during pregnancy

A

effect is estrogen causing congestion, distention, and proliferation of blood vessels. results from increased venous pressure by gravid uterus on femoral and pelvic vessels

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3
Q

hyperpigmentation during pregnancy: who’s more likely to have it, where is it localized

A

women with darker skin tones, localized in nipples, areola, and axillae

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4
Q

linea alba changes in pregnancy

A

darkens and changes to linea nigra. linear streak on midline of abdomen

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5
Q

melasma

A

also known as melasma, mask of pregnancy. symmetric brown hyperpigmentation in malar, mandibular, or central facial areas. made worse by exposure to sun and certain cosmetics

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6
Q

erythema during pregnancy

A

happens in early gestation, appears as either diffuse and mottled or focused in the Palmer and thenar areas

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7
Q

capillary hemangiomas (spider hemangiomas)

A

dilation of arterioles causing erythematosus spots with fine vessels radiating outward. most common areas :gums, tongue, upper lip, eyelids

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8
Q

striae during pregnancy

A

form on breasts, abdomen, and buttocks. form due to structural changes in skin caused by weight gain and hormones. may also be caused by increased activity of adrenal gland during pregnancy

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9
Q

hair distribution changes during pregnancy and postpartum

A

increased hair growth in facial areas and around breasts (2nd and 3rd trimester). thickening of scalp hair in late gestation. common for postpartum hair loss (stops 2 to 6 months postpartum). number of testing hair follicles in testing phase decreased by 1/2, then nearly doubles in 1st few weeks postpartum

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10
Q

nail changes during pregnancy

A

may become brittle, transverse grooving, distal oncholysis and subungal hyperkeratosis. changes benign…no tx needed

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11
Q

erythema during pregnancy differential diagnosis

A

hyperthyroidism, cirrhosis, systemic lupus erythematosus

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12
Q

edema during pregnancy differential diagnosis

A

possible preeclampsia

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13
Q

pronounced nail onychodystrophy during pregnancy could mean pt has…

A

psoriasis, lichen planus, and onychomycosis

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14
Q

tx for striae in pregnancy

A

remedies like vitamin E oil, lubricants, and lotions used..but none are effective.

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15
Q

tx for hyperpigmentation postpartum

A

should resolve itself. if not some people respond to retinoic acid and corticosteroid preparations

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16
Q

tx for vascular changes postpartum

A

should completely regress postpartum…but may be treated with laser, electrodessication, or sclerotherapy

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17
Q

striae postpartum

A

become silvery white and sunken, but rarely disappear

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18
Q

atopic dermatitis pathogenesis during pregnancy

A

estrogen and progesterone modulate immune and inflammatory cell functions, including mast cell secretion. leads to urticaria. may improve or worsen during pregnancy

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19
Q

atopic dermatitis prevention during pregnancy

A

tx to prevent pruritis to discourage itching. maintain skin hydration using thick creams or petroleum jelly

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20
Q

atopic dermatitis signs

A

usually pt has a hx prior to pregnancy. hallmark sign : pruritis. grouped, crusted, erythematous papules and plaques with excoriation . usually in skin creases and flexursl surfaces

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21
Q

atopic dermatitis lab findings

A

no specific findings…but serology, histopathology and immunofluorescense may show elevated IgE

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22
Q

differential diagnosis for atopic dermatitis

A

contact/ allergic dermatitis, tinea infection, scabies, cholestasis, polymorphic eruption of pregnancy. look for distribution of rash to distinguish

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23
Q

complications of atopic dermatitis

A

superinfections. may also have allergic reaction to topical txs

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24
Q

tx for atopic dermatitis

A

tx symptoms with topical corticosteroids (hydrocortisone, systemic antihistamines). if no response may need oral prednisone. DO NOT use methotrexate in pregnancy pts

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25
Q

Koebner phenomenon

A

increased appearance of psoriatic lesions in area of skin trauma.

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26
Q

pathogenesis of psoriasis in pregnancy

A

related to genetics and injury. immune cells move from dermis to epidermis where they stimulate keritanocytes to proliferate. may see high levels of interleukin 10. most patients psoriasis improves during pregnancy

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27
Q

prevention of psoriasis during pregnancy

A

NONE

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28
Q

signs and symptoms of psoriasis

A

red and white scaly patches on top first layer of epidermis. skin accumulates giving silvery white appearance. usually on elbows and knees

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29
Q

lab findings for psoriasis

A

skin biopsy or scraping can confirm diagnosis

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30
Q

psoriasis differential diagnosis

A

drug reactions, pityriasis rosea, contact dermatitis, tinea infection

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31
Q

complications of psoriasis

A

10 to 15% develop psoriatic arthritis

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32
Q

tx for psoriasis

A

phototherapy, topical corticosteroids. DO NOT use methotrexate, cyclosporine, or retinoid

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33
Q

psoriasis prognosis

A

no cure. may develop nonmelanoma skin cancers. need dermatologist regularly. tx symptoms

34
Q

pathogenesis of cutaneous lupus erythematosus

A

binding of autoantibodies to cell membranes in cutaneous tissues initiate immunological cascade leading to lesion formation. most common manifestation of SLE

35
Q

prevention of cutaneous lupus erythematosus

A

UV light may precipitate exacerbation. avoidance may be helpful

36
Q

signs and symptoms of cutaneous lupus erythematosus

A

erythematous papules or small plaques with slight scaling. lesions may expand to large papules

37
Q

lab findings in cutaneous lupus erythematosus

A

positive antinuclear antibody screens. anti-Ro and anti-La should be checked as well as CBC to screen for anemia, leukopenia, and thrombocytopenia. decreased complement and elevated erythroctye sedimentation rate may be seen but are nonspecific

38
Q

special tests for cutaneous lupus erythematosus

A

biopsy of skin shows deposition of immunoglobulin and complement at dermoepidermal junction. use immunofluorescense on older lesions

39
Q

differential diagnosis for cutaneous lupus erythematosus

A

drug eruptions and allergic reactions

40
Q

complications of cutaneous lupus erythematosus

A

if conception occurs during active phase of SLE , 50% of pts will worsen during pregnancy. increased risk of pregnancy loss and premature birth. increased risk for preeclampsia. may see neonatal lupus and congenital heart block

41
Q

tx of cutaneous lupus erythematosus

A

topical and intralesional therapy with steroid tx. scarring may lead to alopecia. if unresponsive, may use antimalarial tx (hydroxychloroquine and systemic corticosteroids)

42
Q

prognosis for cutaneous lupus erythematosus

A

without SLE has good prognosis. may have intermittent exacerbation especially in warmer months

43
Q

cutaneous tumors pathogenesis

A

proliferation of capillaries cause granuloma gravidarum. molluscum fibrosis gravidarum result of hormonal effects on vasculature. with melanocytes may see increase in estrogen and progesterone

44
Q

cutaneous tumor prevention

A

NONE

45
Q

symptoms of granuloma gravidarum

A

red or purple nodule commonly occurring on gingival surfaces in mouth and on fingers

46
Q

symptoms of molluscum fibrosum gravidarum

A

soft fibromas appearing later in pregnancy on face, neck, and chest wall

47
Q

symptoms of melanocytes

A

dark raised nodules of varying sizes that can occur anywhere

48
Q

differential diagnosis for cutaneous tumors

A

rule out wide variety of other tumors. Mets should be considered and rule out malignancy

49
Q

complications of cutaneous tumors

A

maternal cosmetic and physical effects. no fetal impact

50
Q

tx for cutaneous tumors

A

need observation. may needed surgical resection

51
Q

prognosis for cutaneous tumor

A

lesions usually regress postpartum and don’t need surgery

52
Q

pruritic urticarial papules and plaques of pregnancy (PUPPP) pathogenesis

A

most common pruritic dermatosis. also known as polymorphic eruption of pregnancy. happens after 34th week. likely due to overdistention of abdominal connective tissue causing allergic type reaction leading to lesions within striae gravidarum

53
Q

prevention for PUPPP

A

NONE

54
Q

symptoms of PUPPP

A

red unexcoriated papules and plaques found principally on abdomen. marked halo surrounding plaques. lesions found on striae, legs, and arms. characteristic papules spare the periumbilical region leaving white halo in that area

55
Q

lab findings in PUPPP

A

no relevant studies. immunofluorescense can distinguish PUPPP from pemphigoid gestationis since no immunoglobulin component will be identified in PUPPP

56
Q

PUPPP differential diagnosis

A

pemphigoid gestationis, erythema multiple, drug reactions, viral syndromes, scabies

57
Q

tx for PUPPP

A

tx symptoms with antihistamines, topical steroids, and antipruritic medication. may need oral corticosteroids

58
Q

PUPPP prognosis

A

self limiting… resolves within 2 weeks after delivery

59
Q

intrahepatic cholestasis of pregnancy (ICP) pathogenesis

A

usually arises after 30th week, prominent in south American and Scandinavian populations. associated with genetic mutations, increased levels of estrogen and progesterone. dysfunction of biliary secretion leads to elevation of bile salts in skin causing pruritis

60
Q

ICP prevention

A

NONE

61
Q

symptoms of ICP

A

severe pruritis without unidentifiable rash focused on palms and soles. sometimes worse at night. may have excoriation.

62
Q

lab findings with ICP

A

increased serum total bile acid concentration. increased serum cholic acid. serum aminotransferases may be elevated. PTT normal

63
Q

ICP differential diagnosis

A

viral hepatitis, GB disease, pemphigus gestationis, papular dermatoses. absence of rash is distinguishing factor

64
Q

complications from ICP

A

increased risk of adverse prenatal outcomes (preterm birth, stillbirth). circulating bile acids interfere with fetal cardiac conduction causing arrhythmias and sudden stillbirth.

65
Q

tx for ICP

A

Ursodeoxycholic acid may decrease serum bile acid. fetal surveillance needed twice per week after diagnosis. recommended delivery at 36 weeks after confirmation of fetal maturity with amniocentesis

66
Q

ICP prognosis

A

pruritis resolves within days of delivery. recurrs in 40-70% of women especially with use of oral contraceptives. use low dose estrogen pill if oral contraception desired

67
Q

pustular psoriasis of pregnancy pathogenesis

A

also known as impetigo herpetiformis. very rare. associated with high levels of progesterone and low levels of calcium in last trimester.

68
Q

pustular psoriasis of pregnancy prevention

A

NONE

69
Q

signs of pustular psoriasis of pregnancy

A

generalized erythematous patches covered with sterile pustules. start on intertriginous or flexor surfaces and extend centrifugally, including mucous membranes. also fever, nausea, diarrhea and malaise. may have hypocalcaemia

70
Q

lab findings for pustular psoriasis of pregnancy

A

biopsy shows presence of spongiform pustules with neutrophils in epidermis. negative immunofluorescense

71
Q

differential diagnosis pustular psoriasis of pregnancy

A

candidiasis, impetigo. watch for superinfections of lesions making diagnosis difficult

72
Q

complications of pustular psoriasis of pregnancy

A

superinfections of lesions may lead to sepsis. severe hypocalcemia can cause tetany, seizures, and delirium

73
Q

tx of pustular psoriasis of pregnancy

A

oral corticosteroids slowly tapered. calcium supplementation

74
Q

prognosis of pustular psoriasis of pregnancy

A

increased maternal and perinatal mortality (usually related to sepsis). increased risk for placental insufficiency. monitor with fetal surveillance and US

75
Q

pemphigoid gestationis pathogenesis

A

also called herpes gestationis. autoimmune reaction against placental matrix antigen. autoantibodies form leading to deposition of immune complexes in skin and complement activation resulting in tissue damage and blister formation. not caused by herpes.

76
Q

signs of pemphigoid gestationis

A

urticarial papules and plaques beginning on trunk and spreading to entire body. bullous lesions develop as disease progresses. vesicles aren’t clustered. malaise, fever, chills. crust forms, hyperpigmentation

77
Q

prevention of pemphigoid gestationis

A

NONE

78
Q

lab findings of pemphigoid gestationis

A

biopsy needed. most pts have circulating immunoglobulin G that will fix C3 complement. immunofluorescence testing will show C3 in homogenous linear band at basement membrane zone

79
Q

pemphigoid gestationis differential diagnosis

A

pemphigus vulgaris (rule out with histologic exam), dermatitis herpetiformis

80
Q

complications of pemphigoid gestationis

A

ruptured bullae may be painful and develop superficial ulceration that interfere with life. newborns may be small for gestational age at birth (from intrauterine growth restriction)

81
Q

tx for pemphigoid gestationis

A

topical or oral corticosteroids (prednisone 20-60mg daily) , oral histamines

82
Q

pemphigoid gestationis prognosis

A

exacerbation and remission occur during pregnancy. usually abates by 6 weeks postpartum.

AHN 548 Unit 3 (8 decks)

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