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

OB CH 30 Dermatological disorders in pregnancy Flashcards

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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
Koebner phenomenon
increased appearance of psoriatic lesions in area of skin trauma.
26
pathogenesis of psoriasis in pregnancy
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
27
prevention of psoriasis during pregnancy
NONE
28
signs and symptoms of psoriasis
red and white scaly patches on top first layer of epidermis. skin accumulates giving silvery white appearance. usually on elbows and knees
29
lab findings for psoriasis
skin biopsy or scraping can confirm diagnosis
30
psoriasis differential diagnosis
drug reactions, pityriasis rosea, contact dermatitis, tinea infection
31
complications of psoriasis
10 to 15% develop psoriatic arthritis
32
tx for psoriasis
phototherapy, topical corticosteroids. DO NOT use methotrexate, cyclosporine, or retinoid
33
psoriasis prognosis
no cure. may develop nonmelanoma skin cancers. need dermatologist regularly. tx symptoms
34
pathogenesis of cutaneous lupus erythematosus
binding of autoantibodies to cell membranes in cutaneous tissues initiate immunological cascade leading to lesion formation. most common manifestation of SLE
35
prevention of cutaneous lupus erythematosus
UV light may precipitate exacerbation. avoidance may be helpful
36
signs and symptoms of cutaneous lupus erythematosus
erythematous papules or small plaques with slight scaling. lesions may expand to large papules
37
lab findings in cutaneous lupus erythematosus
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
special tests for cutaneous lupus erythematosus
biopsy of skin shows deposition of immunoglobulin and complement at dermoepidermal junction. use immunofluorescense on older lesions
39
differential diagnosis for cutaneous lupus erythematosus
drug eruptions and allergic reactions
40
complications of cutaneous lupus erythematosus
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
tx of cutaneous lupus erythematosus
topical and intralesional therapy with steroid tx. scarring may lead to alopecia. if unresponsive, may use antimalarial tx (hydroxychloroquine and systemic corticosteroids)
42
prognosis for cutaneous lupus erythematosus
without SLE has good prognosis. may have intermittent exacerbation especially in warmer months
43
cutaneous tumors pathogenesis
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
cutaneous tumor prevention
NONE
45
symptoms of granuloma gravidarum
red or purple nodule commonly occurring on gingival surfaces in mouth and on fingers
46
symptoms of molluscum fibrosum gravidarum
soft fibromas appearing later in pregnancy on face, neck, and chest wall
47
symptoms of melanocytes
dark raised nodules of varying sizes that can occur anywhere
48
differential diagnosis for cutaneous tumors
rule out wide variety of other tumors. Mets should be considered and rule out malignancy
49
complications of cutaneous tumors
maternal cosmetic and physical effects. no fetal impact
50
tx for cutaneous tumors
need observation. may needed surgical resection
51
prognosis for cutaneous tumor
lesions usually regress postpartum and don't need surgery
52
pruritic urticarial papules and plaques of pregnancy (PUPPP) pathogenesis
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
prevention for PUPPP
NONE
54
symptoms of PUPPP
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
lab findings in PUPPP
no relevant studies. immunofluorescense can distinguish PUPPP from pemphigoid gestationis since no immunoglobulin component will be identified in PUPPP
56
PUPPP differential diagnosis
pemphigoid gestationis, erythema multiple, drug reactions, viral syndromes, scabies
57
tx for PUPPP
tx symptoms with antihistamines, topical steroids, and antipruritic medication. may need oral corticosteroids
58
PUPPP prognosis
self limiting... resolves within 2 weeks after delivery
59
intrahepatic cholestasis of pregnancy (ICP) pathogenesis
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
ICP prevention
NONE
61
symptoms of ICP
severe pruritis without unidentifiable rash focused on palms and soles. sometimes worse at night. may have excoriation.
62
lab findings with ICP
increased serum total bile acid concentration. increased serum cholic acid. serum aminotransferases may be elevated. PTT normal
63
ICP differential diagnosis
viral hepatitis, GB disease, pemphigus gestationis, papular dermatoses. absence of rash is distinguishing factor
64
complications from ICP
increased risk of adverse prenatal outcomes (preterm birth, stillbirth). circulating bile acids interfere with fetal cardiac conduction causing arrhythmias and sudden stillbirth.
65
tx for ICP
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
ICP prognosis
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
pustular psoriasis of pregnancy pathogenesis
also known as impetigo herpetiformis. very rare. associated with high levels of progesterone and low levels of calcium in last trimester.
68
pustular psoriasis of pregnancy prevention
NONE
69
signs of pustular psoriasis of pregnancy
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
lab findings for pustular psoriasis of pregnancy
biopsy shows presence of spongiform pustules with neutrophils in epidermis. negative immunofluorescense
71
differential diagnosis pustular psoriasis of pregnancy
candidiasis, impetigo. watch for superinfections of lesions making diagnosis difficult
72
complications of pustular psoriasis of pregnancy
superinfections of lesions may lead to sepsis. severe hypocalcemia can cause tetany, seizures, and delirium
73
tx of pustular psoriasis of pregnancy
oral corticosteroids slowly tapered. calcium supplementation
74
prognosis of pustular psoriasis of pregnancy
increased maternal and perinatal mortality (usually related to sepsis). increased risk for placental insufficiency. monitor with fetal surveillance and US
75
pemphigoid gestationis pathogenesis
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
signs of pemphigoid gestationis
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
prevention of pemphigoid gestationis
NONE
78
lab findings of pemphigoid gestationis
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
pemphigoid gestationis differential diagnosis
pemphigus vulgaris (rule out with histologic exam), dermatitis herpetiformis
80
complications of pemphigoid gestationis
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
tx for pemphigoid gestationis
topical or oral corticosteroids (prednisone 20-60mg daily) , oral histamines
82
pemphigoid gestationis prognosis
exacerbation and remission occur during pregnancy. usually abates by 6 weeks postpartum.

AHN 548 Unit 3 (8 decks)

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