Pruritic Folliculitis in Pregnancy - Causes, Diagnosis, and Treatment

Introduction

Pruritic folliculitis in pregnancy is a rare disease. It occurs mainly during pregnancy. The symptoms of pruritic folliculitis of pregnancy usually resolve after the delivery (postpartum). It is distinguished by a benign skin condition (dermatosis). Papules and pustular follicular lesions first occur on the torso and sometimes spread throughout the body. Therefore, pruritic folliculitis in pregnancy has a lot of differential diagnoses. However, histopathological tests revealed changes consistent with pruritic folliculitis during pregnancy. Therefore, diagnosis is made with its distinctive nature and clinical and histopathological characteristics.

What Is Pruritic Folliculitis in Pregnancy?

Pruritic folliculitis of pregnancy (PFP) is a benign, specific skin condition (dermatosis) with follicular lesions with papules and pustules. The lesions are primarily seen on the torso and then spread throughout the body. Zoberman and Farmer described pruritic folliculitis of pregnancy (PFP) in 1981. Pruritic folliculitis of pregnancy (PFP) dermatosis starts in the second or third trimester, more likely from the fourth to the ninth month of pregnancy. It involves gilts and multiparous women. The symptoms stay between two and three weeks, with immediate regression after delivery. The exact etiology of pruritic folliculitis of pregnancy (PFP) is unknown, mainly due to its infrequent occurrence. Pruritic folliculitis of pregnancy (PFP) has no maternal or fetal complications.

What Causes Pruritic Folliculitis in Pregnancy?

The exact cause of pruritic folliculitis in pregnancy is unknown. Hormonal changes during pregnancy are believed to cause it. However, it does not appear to be caused by irregularities in the parent's immune system. Pruritic folliculitis of pregnancy typically forms in the second and third trimesters. It resolves spontaneously after delivery within two to eight weeks. The good news is that this rash is benign and has no adverse effects on the baby.

What Are the Symptoms of Pruritic Folliculitis in Pregnancy?

The rash consists of several small red bumps and pustules that may or may not be filled with pus called abscesses. The condition resembles acne, but the significant difference is that no bacteria are present in the bumps in pruritic folliculitis. The pustules are sterile. These symptoms are usually observed on the shoulders, upper back, arms, chest, and abdomen. Itching is present. The clinical features of pruritic folliculitis in pregnancy are mentioned below.

• Pruritic folliculitis of pregnancy (PFP) is represented by an acneiform eruption consisting of features that include multiple pruritic, 2 to 4 mm, follicular papules or pustules.

• Symptoms generally on the shoulders, upper back, arms, chest, and abdomen.

• The rash usually starts over the abdomen, typically involving the striae gravidarum.

• It may spread to the breasts, arms, and upper thighs.

• The face, palms, soles, and mucosal surfaces usually are rarely involved.

• The lesions commonly consist of polymorphous, erythematous, non-follicular papules, plaques, and sometimes vesicles.

• The lesions can be painful.

• The rash usually resolves near-term or in the early postpartum period.

How to Diagnose Pruritic Folliculitis in Pregnancy?

Pruritic folliculitis of pregnancy is a rare skin condition observed during pregnancy and resolved after delivery. The lesions resemble acne, and the signs and symptoms of pruritic folliculitis in pregnancy are similar to other conditions common in pregnancy. The diagnosis is made with

1. Physical Examination

• Small, 3 to 5 mm erythematous papules, and the symptoms are present on the upper torso.

• follicular erythematous papules.

• Pustular lesions.

• In severe cases, prurigo is present.

• Central crusts in the lumbar area.

2. Biopsy

An incisional biopsy can be done on one of the lesions on the lower back. Histopathology shows the following features.

• Epidermis.

• Mild psoriasiform acanthosis.

• Wedge-shaped dermis.

• Inflammatory infiltrates small and medium-sized mononuclear cells found around the vessels.

• Discrete leukocytoclastic cells are present.

• Slightly beveled cores were also found.

3. Immunohistochemistry.

Immunohistochemistry was positive for myeloperoxidase, HAM56 (a monoclonal antibody), lysozyme, and CD3 (a protein complex).

So it is essential to avoid misdiagnosis and also helps in the differential diagnosis. Some of the differential diagnoses of pruritic folliculitis in pregnancy are mentioned below.

• Gestational pemphigoid.

• Pruritic urticarial papules and plaques of pregnancy (PUPPP).

• Prurigo of pregnancy.

• Acne.

• Bacterial folliculitis

Acne

Acne is a common and chronic skin problem due to the formation of blocks in the sebaceous glands. Sebaceous glands are tiny glands containing sebum. Sebum is an oily substance secreted into the skin surface—increased production of sebum, dead cells, and bacteria accumulated to form a clog. Clog in the sebaceous gland leads to the inflammation of the gland causing the conditions like acne and pimples. In addition, acne can sometimes lead to other skin problems, including whiteheads, blackheads, cysts, nodules, and spots. Acne can also appear in the face, shoulders, chest, arms, and back region. Acne has no age predilection. Acne has several types, and the types of acne are given below.

• Whiteheads are the bump beneath the skin due to the plugging of hair follicles.

• Blackheads and clogged hair follicles form on the skin's surface and look black.

• Papules, small pink inflamed and painful lesions.

• Pustules, red lesions with pus.

• Nodules, large deep-seated lesions.

• Cystic acne is called severe nodular acne, a painful deep lesion with pus.

How to Treat Pruritic Folliculitis during Pregnancy?

Pruritic folliculitis of pregnancy is a benign self-limiting condition, and the treatment is mainly done to manage the symptoms. The various treatment measures to manage the symptoms of pruritic folliculitis in pregnancy are mentioned below.

• Topical medications such as low-potency corticosteroids.

• 10% benzoyl peroxide.

• Combination therapy.

• UVB (ultraviolet therapy B) therapy.

• Antifungal medications.

• Topical or systemic antibiotics.

• If the lesions are asymptomatic, their natural resolution after delivery should be considered.

• Pruritic folliculitis lesions develop during pregnancy and fade within weeks after delivery.

Conclusion

Pruritic folliculitis of pregnancy is a rare dermatosis condition characterized by papules and pustules. The symptoms appear in the second and third trimesters of pregnancy. Symptoms resolve after the delivery. Proper diagnosis is made to avoid misdiagnosis, and treatment is done to manage the symptoms. Topical corticosteroids will provide symptomatic relief. However, the pruritic folliculitis of pregnancy has no fetal or maternal complications.