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Dermatoses of Pregnancy - An Overview

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Dermatoses are heterogeneous pruritic skin eruptions present during pregnancy. Read this article to know this condition's causes, symptoms, and treatments.

Medically reviewed by

Dr. Nidhin Varghese

Published At November 2, 2022
Reviewed AtNovember 1, 2023

What Are Dermatoses of Pregnancy?

Dermatoses are heterogeneous inflammatory pruritic skin eruptions that occur exclusively during pregnancy or after childbirth. Dermatoses of pregnancy are also known as 'polymorphic eruptions of pregnancy.' These dermatoses occur specifically during pregnancy due to various hormonal and physiological changes in a pregnant woman. Most of these skin conditions resolve after childbirth and only require symptomatic treatment.

Dermatoses of pregnancy include -

  1. Pemphigoid gestationis (gestational pemphigoid).

  2. Plaques of pregnancy- pruritic urticarial papules and plaques of pregnancy (PUPPP).

  3. Atopic eruption of pregnancy (eczema, prurigo, or pruritic folliculitis).

  4. Intrahepatic cholestasis of pregnancy.

What Are the Different Dermatoses of Pregnancy?

Details like causes, symptoms, diagnosis, and management of different kinds of dermatoses that occur specifically during pregnancy are as follows -

1. Pemphigoid Gestationis (PG) -

  • It is a rare autoimmune disorder that is vesiculobullous and highly pruritic.

  • Generally develops in the third trimester of the pregnancy or immediately after childbirth.

Symptoms -

  • Initially, it starts as a burning and itching sensation in the periumbilical region.

  • Reddish rashes or plaques appear on the abdomen, trunk, back, buttocks, and limbs.

  • These plaques gradually turn into large blisters (bullae).

  • Blisters are pruritic (filled with clear liquid or blood-stained liquid).

  • After a few weeks post-delivery, this condition remits and does not leave any scars.

Diagnosis -

  • Antibody detection- by skin biopsy or blood tests.

  • Direct or indirect immunofluorescence tests are positive.

Management -

  • Emollient creams or lotions to reduce rashes and pruritus.

  • Daily administration of oral antihistamines decreases pruritus (for example- Cetrizine or Loratidine).

  • Daily oral steroids (Prednisolone) are given to control the symptoms rapidly in severe cases.

  • In extremely severe cases, plasmapheresis and immunosuppressive drugs can be considered. Plasmapheresis is the process of withdrawing blood and separating its components, then transfusing the blood cells back into the body after removing blood plasma.

  • The prognosis of this condition is usually good for mothers who might have a normal delivery. However, the situation improves significantly after delivery when the mother starts breastfeeding the baby.

  • In some cases, the rashes might be transferred to the newborn, which can last for a few weeks and then disappear.

  • In severe cases, if the patient is under oral steroids therapy, there is a risk of developing hypertension, diabetes, placental insufficiency, adrenal insufficiency, preterm birth, or even stillbirth.

  • Regular checkups, including urine tests, blood pressure, and ultrasounds (to evaluate the baby's proper development), help decrease the associated risks.

2. Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP) -

  • Usually affects primigravida (woman with first-time pregnancy) in the third trimester or after childbirth. Women with excessive maternal weight gain or pregnant with multiple gestations (twins or triplets) are more prone to this condition.

  • It is a self-limiting disorder characterized by pruritic inflammatory urticarial papules and plaques.

Symptoms -

  • Itchy rashes appear in the abdomen, then spread to the trunk, lower abdomen, and limbs.

  • Rashes transform into plaques, small blisters, cysts, or eczematous lesions.

  • The condition usually resolves after a few weeks of childbirth with no scars.

Diagnosis -

  • Tests like skin biopsy or blood tests can be performed to rule out other similar skin conditions.

  • Direct or indirect immunofluorescence tests are negative.

Management -

  • Creams or lotions with topical steroids can be applied in mild cases.

  • Potent topical steroid creams or oral steroids can be used in severe cases.

  • Daily administration of oral antihistamines decreases pruritus (example- Cetrizine or Loratidine).

  • PUPPP is a self-limiting and benign condition; thus, the prognosis is usually good for both mother and the fetus. In addition, no skin lesions are present at birth in newborns.

  • Early elective induction of labor can be done in severe cases.

  • Regular checkups should be done throughout pregnancy.

3. Atopic Eruption of Pregnancy (AEP) -

  • Atopic eruptions of pregnancy are clinically present as eczematous lesions (E-type lesions) or prurigo lesions (P-type lesions).

  • It is a benign self-limiting condition with pruritis.

  • Primarily seen in women with a personal or family history.

  • It can affect pregnant women throughout pregnancy. But, most women in their second or early third trimester are more prone to it.

Symptoms -

  • Eczematous lesions or prurigo lesions on the skin.

  • Severe pruritus that increases during night hours.

  • Secondary infections and lesions due to itching.

  • The lesions are primarily present in the face, neck, chest, and extremities.

Diagnosis -

  • Blood tests or skin biopsies can be performed.

  • Tests show an increased level of IgE levels and hypereosinophilia.

  • Direct immunofluorescence tests are negative.

Management -

  • Creams or lotions with topical steroids can be applied in mild cases.

  • Potent topical steroid creams or oral steroids can be used in severe cases.

  • Daily administration of oral antihistamines decreases pruritus (for example- Cetrizine or Loratidine).

  • If the skin lesions get secondarily infected, topical and oral antibiotics can be taken.

  • To reduce pruritus- emollient creams with urea, menthol, and Polidocanol.

  • The prognosis is good for the mother, but the infant might develop atopic skin changes.

  • Weekly checkups must be done throughout pregnancy.

  • Breastfeeding can be done.

4. Intrahepatic Cholestasis of Pregnancy (ICP) -

  • It is a reversible type of cholestasis (a condition where bile flow from the liver is either blocked or slowed down).

  • It starts in the later stages of pregnancy (second or third trimester)

  • The main factors responsible for ICP are hormonal factors (estrogen and progesterone), genetic factors, environmental factors, and other factors (low serum selenium levels).

Symptoms -

  • Most of the cases show a family history of cholestasis.

  • Nausea.

  • Primary skin lesions are not evident. However, secondary lesions may develop due to severe itching.

  • Loss of appetite.

  • Severe pruritus is present, which usually worsens in the evening or night.

  • Jaundice- yellowing of the skin and whites of the eyes.

Diagnosis -

  • Serum bile acid levels of more than 11.0 μmol/l show a positive diagnosis.

Management -

  • Daily administration of oral antihistamines decreases pruritus (for example- Cetirizine or Loratidine).

  • Emollient creams or lotions to reduce rashes and pruritus.

  • Vitamin K supplements in cases of fat malabsorption (to avoid postpartum hemorrhage).

  • Drug of choice: Ursodeoxycholic acid (UDCA) 15mg/kg/day.

  • Chances of recurrence in subsequent pregnancies.

  • Out of all types of dermatoses of pregnancy, ICP is considered the most dangerous one as it can cause premature birth, intrapartum fetal distress, or stillbirths.

  • The prognosis is good for the mother. No risk of early abortion is present.

  • Weekly checkups, ultrasounds, and serum bile acid levels must be monitored throughout pregnancy.

  • Breastfeeding can be done.

Conclusion:

Skin conditions during pregnancy are common and are generally self-limiting and benign. Dermatoses of pregnancy are usually associated with abrupt skin eruptions that are inflammatory and pruritic. However, symptoms of dermatoses may appear in some women during pregnancy or postpartum, which can be associated with severe outcomes such as fetal distress, premature birth, or stillbirth. Therefore, proper clinical diagnosis and early management are essential to achieve a better result for both the mother and the fetus.

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Dr. Nidhin Varghese
Dr. Nidhin Varghese

Dermatology

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