Synopsis
-
Pregnancy Dermatoses
-
Specific dermatoses of pregnancy are of unknown aetiology. The most frequent dermatosis of pregnancy are pruritic urticarial papules and plaques of pregnancy (PUPPP). They occur predominantly in the third trimenon. In rare cases, they have also been observed outside pregnancy. For treatment, external or even systemic glucocorticoids are recommended and the prognosis is good.
Atopic eczema in pregnancy (AEP) is the most common pruritic condition in pregnancy, seen in almost 50% of patients. Skin lesions start commonly during early pregnancy. Lesio.ns comprise features and distribution of chronic eczema with lichenfication, vesiculous and pruriginous papules together with intense pruritus. For treatment, external glucocorticoids are used.
Pemphigoid gestationis (PG) is rare. Epidermal basement membrane zone antibodies are present in serum, binding to the 180-kD antigen of bullous pemphigoid. Patients experience abrupt onset of an intensely pruritic urticarial lesion in the second or third trimester. The antibodies may be transferred to the foetus, so that the newborn suffers from similar cutaneous lesions. For treatment, systemic glucocorticoids are used.
-
Pigmentation disorders are common in pregnancy affecting up to 50-70% of women. Higher incidence of chloasma gravidarum or melasma occurs in women with skin type III or higher. Genetic and environmental factors, in particular UV exposure, contribute to intensity of chloasma.
-
General skin diseases may occur incidentally in pregnancy. It remains to be clarified whether the incidence is higher than in a comparable time period of women of similar age; satisfying statistical comparisons are not available in literature. 60-88% of women develop striae during pregnancy. Risk factors are: family history of striae in the mother, baseline and delivery body mass index, and striae reported outside the pregnancy.
-
Pregnancy and skin tumours: Lack of immune rejection of the embryo and foetus is based on site-specific immunosuppression at the foetal-maternal interface, but the peripheral immune response of the mother is uninhibited. Earlier, it was a doctrine that a woman who had melanoma should not become pregnant. In some series, women who were pregnant at the time of diagnosis exhibited unfavourable survival prospects. More recent studies, have however refuted this suggestion. The monitoring of nevi in pregnancy has also failed to reveal any reliable changes.
-
Autoimmune Progesterone Dermatitis
Autoimmune progesterone dermatitis is a rare disease. The aetiopathogenesis remains unclear; the autoimmune origin is not sufficiently proven. The features of autoimmune progesterone dermatitis include eczema, purpura, erythema multiforme, and urticaria. Histopathologically, the skin lesions are usually described as an eosinophilic non-specific vasculitis. For diagnosis, eruptions 7 days before menses and resolving after 1-3 days thereafter as well as positive skin test to progesterone are essential. Treatment of current troubles requires antihistamines and/or glucocorticoids, but the inhibition of endogenous progesterone secretion is essential.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Alcalay J, Ingber A, Kafri B, Segal J, Kaufmann H, Hazaz B, Sandbank M. Hormonal evaluation and autoimmune background in pruritic urticarial papules and plaques of pregnancy. Am J Obstet Gynecol. 1988;158(2):417–20.
Alexander H, Zimmermann G, Wolkersdörfer G W, Biesold C, Lehmann M, Einenkel J, Pretzsch G, Baier D. Utero-ovarian interaction in the regulation of reproductive function. Hum Reprod Update. 1998;4(5):550–9.
Ambros-Rudolph CM, Müllegger RR, Vaughan-Jones SA, Kerl H, Black MM. The specific der-matoses of pregnancy revisited and reclassified: results of a retrospective two-center study on 505 pregnant patients. 9a-17. J Am Acad Dermatol. 2006;54(3):395–404.
Arck P, Hansen PJ, Mulac Jericevic B, Piccinni M P, Szekeres-Bartho J. Progesterone during pregnancy: endocrine-immune cross talk in mammalian species and the role of stress. Am J Reprod Immunol. 2007;58(3):268–79.
Aronson IK, Bond S, Fiedler VC, Vomvouras S, Gruber D, Ruiz C. Pruritic urticarial papules and plaques of pregnancy: clinical and immunopathologic observations in 57 patients. J Am Acad Dermatol 1998;39(6): 933–9.
Baptist A P, Baldwin JL. Autoimmune progesterone dermatitis in a patient with endometriosis: case report and review of the literature. Clin Mol Allergy. 2004;2(1):10.
Bemanian MH, Gharagozlou M, Farashahi MH, Nabavi M, Shirkhoda Z. Autoimmune progesterone anaphylaxis. Iran J Allergy Asthma Immunol. 2007;6(2):97–9.
Blois SM, Kammerer U, Alba Soto C, Tometten MC, Shaikly V, Barrientos G, Jurd R, Rukavina D, Thomson AW, Klapp BF, Fernández N, Arck PC. Dendritic cells: key to fetal tolerance? Biol Reprod. 2007;77(4):590–8.
Buccolo LS, Viera AJ. Pruritic urticarial papules and plaques of pregnancy presenting in the post-partum period: a case report. J Reprod Med. 2005;50(1):61–3.
Chang AL, Agredano YZ, Kimball AB. Risk factors associated with striae gravidarum. J Am Acad Dermatol. 2004;51(6):881–5.
Cocuroccia B, Gisondi P, Gubinelli E, Girolomoni G. Autoimmune progesterone dermatitis. Gyne-col Endocrinol. 2006;22(1):54–6.
Cohen LM, Capeless EL, Krusinski PA, Maloney ME. Pruritic urticarial papules and plaques of pregnancy and its relationship to maternal-fetal weight gain and twin pregnancy. Arch Derma-tol. 1989;125(11):1534–6.
Daniels TE, Quadra-White C. Direct immunofluorescence in oral mucosal disease: a diagnostic analysis of 130 cases. Oral Surg Oral Med Oral Pathol. 1981;51(1): 38–47.
Dedecker F, Graesslin O, Quereux C, Gabriel R. Autoimmune progesterone dermatitis: A rare pathology. Eur J Obstet Gynecol Reprod Biol. 2005;123, 121
Elling S V, McKenna P, Powell FC. Pruritic urticarial papules and plaques of pregnancy in twin and triplet pregnancies. J Eur Acad Dermatol Venereol. 2000;14(5):378–81.
Errickson C V, Matus NR. Skin disorders of pregnancy. Am Fam Physician. 1994;49(3):605–10.
Esteve E. Les dermatoses aux oestrogènes et à la progesterone: une nosologie en devenir. Editorial. Ann Dermatol Venereol. 1998;125:484–5.
Ghasemi A, Gorouhi F, Rashighi-Firoozabadi M, Jafarian S, Firooz A. Striae gravidarum: associated factors. J Eur Acad Dermatol Venereol. 2007;21(6):743–6.
Ghosh D, Sengupta J. Recent developments in endocrinology and paracrinology of blastocyst implantation in the primate. Hum Reprod Update. 1998;4(2):153–68.
Grin CM, Driscoll MS, Grant-Kels JM. The relationship of pregnancy, hormones, and melanoma. Semin Cutan Med Surg. 1998;17(3):167–71.
Halevy S, Cohen AD, Lunenfeld E, Grossman N. Autoimmune progesterone dermatitis manifested as erythema annulare centrifugum: Confirmation of progesterone sensitivity by in vitro inter-feron-gamma release. J Am Acad Dermatol. 2002;47(2):311–3.
Hertl M. (ed). Autoimmune diseases of the skin: pathogenesis, diagnosis, management. 2nd Ed., Springer, New York, 2005
High WA, Hoang M P, Miller MD. Pruritic urticarial papules and plaques of pregnancy with unusual and extensive palmoplantar involvement. Obstet Gynecol. 2005;105(5 Pt 2):1261–4.
Holmes RC, Black MM. The specific dermatoses of pregnancy. J Am Acad Dermatol. 1983 Mar;8(3):405–12.
Jolliffe DS, Sim-Davis D. Cicatricial pemphigoid in a young girl: report of a case. Clin Exp Der-matol. 1977;2(3): 281–4.
Kakarla N, Zurawin RK. A case of autoimmune progesterone dermatitis in an adolescent female. J Pediatr Adolesc Gynecol. 2006;19(2):125–9.
Kayisli UA, Guzeloglu-Kayisli O, Arici A. Endocrine-immune interactions in human endometrium. Ann N Y Acad Sci. 2004;1034:50–63.
Koch CA, Platt JL. T cell recognition and immunity in the fetus and mother. Cell Immunol. 2007;248(1):12–7.
Kumari R, Jaisankar TJ, Thappa DM. A clinical study of skin changes in pregnancy. Indian J Der-matol Venereol Leprol. 2007;73(2):141.
Lakhdar H, Zouhair K, Khadir K, Essari A, Richard A, Seité S, Rougier A. Evaluation of the effectiveness of a broad-spectrum sunscreen in the prevention of chloasma in pregnant women. J Eur Acad Dermatol Venereol. 2007;21(6):738–42.
Laskaris G, Angelopoulos A. Cicatricial pemphigoid: direct and indirect immunofluorescent studies. Oral Surg Oral Med Oral Pathol. 1981;51(1): 48–54.
Lawley TJ, Hertz KC, Wade TR, Ackerman AB, Katz SI. Pruritic urticarial papules and plaques of pregnancy. JAMA. 1979;241(16):1696–9.
Lea RG, Sandra O. Immunoendocrine aspects of endometrial function and implantation. Reproduction. 2007;134(3):389–404.
Matz H, Orion E, Wolf R. Pruritic urticarial papules and plaques of pregnancy: polymorphic eruption of pregnancy (PUPPP). Clin Dermatol. 2006;24(2):105–8.
Muzaffar F, Hussain I, Haroon TS. Physiologic skin changes during pregnancy: a study of 140 cases. Int J Dermatol. 1998;37(6):429–31.
Nilles M, Weyers W, Gründer K. Die PUPPP Dermatose. Hautarzt. 1989;40(9):586–8.
Ohel I, Levy A, Silberstein T, Holcberg G, Sheiner E. Pregnancy outcome of patients with pruritic urticarial papules and plaques of pregnancy. J Matern Fetal Neonatal Med. 2006;19(5):305–8.
Oskay T, Kutluay L, Kaptanoglu A, Karabacak O. Autoimmune progesterone dermatitis. Eur J Dermatol. 2002;12(6):589–91.
Osman H, Rubeiz N, Tamim H, Nassar AH. Risk factors for the development of striae gravidarum. Am J Obstet Gynecol. 2007;196(1):62.e1–5.
Rampen FH. Sex differences in survival from cutaneous melanoma. Int J Dermatol. 1984;23(7): 444–52.
Roger D, Vaillant L, Fignon A, Pierre F, Bacq Y, Brechot J F, Grangeponte MC, Lorette G. Specific pruritic diseases of pregnancy. A prospective study of 3192 pregnant women. Arch Dermatol. 1994;130(6):734–9.
Rubegni P, Sbano P, Burroni M, Cevenini G, Bocchi C, Severi FM, Risulo M, Petraglia F, Dell'Eva G, Fimiani M, Andreassi L. Melanocytic skin lesions and pregnancy: digital dermoscopy analysis. Skin Res Technol. 2007;13(2):143–7.
Saito S, Shiozaki A, Sasaki Y, Nakashima A, Shima T, Ito M. Regulatory T cells and regulatory natural killer (NK) cells play important roles in feto-maternal tolerance. 9: Semin Immun-opathol. 2007;29(2):115–22.
Seeger JD, Lanza LL, West WA, Fernandez C, Rivero E. Pregnancy and pregnancy outcome among women with inflammatory skin diseases. Dermatology. 2007;214(1):32–9.
Sheiner E, Ohel I, Levy A, Katz M. Pregnancy outcome in women with pruritus gravidarum. J Reprod Med. 2006;51(5):394–8.
Sherard GB 3rd, Atkinson SM Jr. Focus on primary care: pruritic dermatological conditions in pregnancy. Obstet Gynecol Surv. 2001;56(7):427–32.
Silipo V, De Simone P, Mariani G, Buccini P, Ferrari A, Catricala C. Malignant melanoma and pregnancy. Melanoma Res. 2006;16(6):497–500.
Snyder JL, Krishnaswamy G. Autoimmune progesterone dermatitis and its manifestation as ana-phylaxis: a case report and literature review. Ann Allergy Asthma Immunol. 2003;90:469–77.
Steen VD. Pregnancy in scleroderma. Rheum Dis Clin North Am. 2007;33(2):345–58, vii.
Stranahan D, Rausch D, Deng A, Gaspari A. The role of intradermal skin testing and patch testing in the diagnosis of autoimmune progesterone dermatitis. Dermatitis. 2006;17(1):39–42.
Thomas RG, Liston WA. Clinical associations of striae gravidarum. J Obstet Gynaecol. 2004;24(3): 270–1.
Tunzi M, Gray GR. Common Skin Conditions During Pregnancy. Fam Physician. 2007;75:211–8
Uhlin SR. Pruritic urticarial papules and plaques of pregnancy. Involvement in mother and infant. Arch Dermatol. 1981;117(4):238–9.
Vaughan Jones SA, Hern S, Nelson-Piercy C, Seed PT, Black MM. A prospective study of 200 women with dermatoses of pregnancy correlating clinical findings with hormonal and immun-opathological profiles. Br J Dermatol. 1999;141(1):71–81.
Weatherhead S, Robson SC, Reynolds NJ. Management of psoriasis in pregnancy. BMJ. 2007;334(7605): 1218–20.
Weiss R, Hull P. Familial occurrence of pruritic urticarial papules and plaques of pregnancy. J Am Acad Dermatol. 1992;26(5 Pt 1):715–7.
Wilkinson SM, Beck MH, Kingston T P. Progesterone-induced urticaria —need it be autoimmune? Br J Dermatol. 1995;133:792–4.
Wintzen M, Goor-van Egmond MB, Noz KC. Autoimmune progesterone dermatitis presenting with purpura and petechiae. Clin Exp Dermatol. 2004;29(3):316.
Zampetti A, Feliciani C, Landi F, Capaldo ML, Rotoli M, Amerio PL. Management and dermos-copy of fast-growing nevi in pregnancy: case report and literature review. J Cutan Med Surg. 2006;10(5):249–52.
Zampino MR, Corazza M, Costantino D, Mollica G, Virgili A. Are melanocytic nevi influenced by pregnancy? A dermoscopic evaluation. Dermatol Surg. 2006;32(12):1497–504.
Zurn A, Celebi CR, Bernard P, Didierjean L, Saurat JH. A prospective immunofluorescence study of 111 cases of pruritic dermatoses of pregnancy: IgM anti-basement membrane zone antibodies as a novel finding. Br J Dermatol. 1992;126(5): 474–8.
Rights and permissions
Copyright information
© 2009 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
(2009). Gestagens. In: Cutaneous Manifestations of Endocrine Diseases. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-88367-8_9
Download citation
DOI: https://doi.org/10.1007/978-3-540-88367-8_9
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-88366-1
Online ISBN: 978-3-540-88367-8
eBook Packages: MedicineMedicine (R0)