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Specific Dermatoses of Pregnancy

  • Arieh Ingber
Chapter

Abstract

A group of skin diseases that occur specifically in pregnant women. The following diseases will be discussed in depth: Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP), Pemphigoid Gestationis (PG), Impetigo Herpetiformis (IH), Prurigo of Pregnancy (Besnier), Pruritic Folliculitis of Pregnancy and Linear IgM Dermatosis of Pregnancy. The nomenclature and the specificity of these diseases is not clear and causing confusion. The purpose of this chapter is to set and simplify this group of unique skin conditions.

Keywords

Pregnancy Specific dermatoses Puppp Pemphigoid gesttationis Impetigo herpetiformis Prurigo of pregnancy Pruritic folliculitis Linear IgM 

References

  1. 1.
    Danesh M, Pomeranz MK, McMeniman E, Murase JE. Dermatoses of pregnancy: nomenclature, misnomers, and myths. Clin Dermatol. 2016;34:314–9.CrossRefGoogle Scholar
  2. 2.
    Holmes RC, Black MM. The specific dermatoses of pregnancy: a reappraisal with special emphasis on a proposed simplified clinical classification. Clin Exp Dermatol. 1982;7:65–73.CrossRefGoogle Scholar
  3. 3.
    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 immunopathological profiles. Br J Dermatol. 1999;141:71–81.CrossRefGoogle Scholar
  4. 4.
    Lawley TJ, Hertz KC, Wade TR, Ackerman AB, Katz SI. Pruritic urticarial papules and plaques of pregnancy. JAMA. 1979;241:1696–9.CrossRefGoogle Scholar
  5. 5.
    Dehdashti AL, Wikas SM. Pruritic urticarial papules and plaques of pregnancy occurring postpartum. Cutis. 2015;95:344–7.Google Scholar
  6. 6.
    Ghazeeri G, Kibbi AG, Abbas O. Pruritic urticarial papules and plaques of pregnancy: epidemiological, clinical, and histopathological study of 18 cases from Lebanon. Int J Dermatol. 2012;51:1047–53.CrossRefGoogle Scholar
  7. 7.
    Thurston A, Grau RH. An update on the dermatoses of pregnancy. J Okla State Med Assoc. 2008;101:7–11.Google Scholar
  8. 8.
    Rudolph CM, Al-Fares S, Vaughan-Jones SA, Müllegger RR, Kerl H, Black MM. Polymorphic eruption of pregnancy: clinicopathology and potential trigger factors in 181 patients. Br J Dermatol. 2006;154:54–60.CrossRefGoogle Scholar
  9. 9.
    Aractingi S, Berkane N, Bertheau P, Le Goué C, Dausset J, Uzan S, Carosella ED. Fetal DNA in skin of polymorphic eruptions of pregnancy. Lancet. 1998;352:1898–901.CrossRefGoogle Scholar
  10. 10.
    Woidacki K, Zenclussen AC, Siebenhaar F. Mast cell-mediated and associated disorders in pregnancy: a risky game with an uncertain outcome? Front Immunol. 2014;5:231.CrossRefGoogle Scholar
  11. 11.
    Jeon IK, On HR, Oh SH, Hann SK. Three cases of pruritic urticarial papules and plaques of pregnancy (PUPPP) treated with intramuscular injection of autologous whole blood. J Eur Acad Dermatol Venereol. 2015;29:797–800.CrossRefGoogle Scholar
  12. 12.
    Brandão P, Sousa-Faria B, Marinho C, Vieira-Enes P, Melo A, Mota L. Polymorphic eruption of pregnancy: review of literature. J Obstet Gynaecol. 2017;37:137–40.Google Scholar
  13. 13.
    Taylor D, Pappo E, Aronson IK. Polymorphic eruption of pregnancy. Clin Dermatol. 2016;34:383–91.CrossRefGoogle Scholar
  14. 14.
    Kraumpouzos G, Cohen LM. Dermatoses of pregnancy. J Am Acad Dermatol. 2003;45:1–19.CrossRefGoogle Scholar
  15. 15.
    Callen JP, Hanno R. Pruritic urticarial papules and plaques of pregnanacy. A clinicopathologic study. J Am Acad Dermatol. 1981;5:401–5.CrossRefGoogle Scholar
  16. 16.
    Callen JP. Pregnancy’s effects on the skin. Common and uncommon changes. Postgrad Med. 1984;75:138–45.CrossRefGoogle Scholar
  17. 17.
    Shornik JK. Dermatoses of pregnancy. Semin Cutan Med Surg. 1988;17:172–81.CrossRefGoogle Scholar
  18. 18.
    Schmidt E, Zillikens D. Pemphigoid diseases. Lancet. 2013;381:320–32.CrossRefGoogle Scholar
  19. 19.
    Kroumpouzos G, Zillikens D. Pemphigoid gestationis. In: Kroumpouzos G, editor. Text atlas of obstetric dermatology. Philadelphia: Lippincott Williams & Wilkins; 2013. p. 180–93.Google Scholar
  20. 20.
    Shornick JK, Stastny P, Gilliam JN. High frequency of histocompatibility antigens HLA-DR3 and DR4 in herpes gestations. J Clin Invest. 1981;68:553–5.CrossRefGoogle Scholar
  21. 21.
    Chimanovitch I, Schmidt E, Messer G, et al. IGG1 and IGG3 are the major immunoglobulin subclasses targeting epitopes within the NC16A domain of BP180 in pemphigoid gestationis. J Invest Dermatol. 1999;113:140–2.CrossRefGoogle Scholar
  22. 22.
    Sadik CD, Lima AL, Zillikens D. Pemphigoid gestationis: toward a better understanding of the etiopathogenesis. Clin Dermatol. 2016;34(3):378–82.CrossRefGoogle Scholar
  23. 23.
    Tani N, Kimura Y, Koga H, Kawakami T, Ohata C, Ishii N, Hashimoto T. Clinical and immunological profiles of 25 patients with pemphigoid gestationis. Br J Dermatol. 2015;172:120–9.CrossRefGoogle Scholar
  24. 24.
    Jenkins RE, Hern S, Black MM. Clinical features and management of 87 patients with pemphigoid gestationis. Clin Exp Dermatol. 1999;24:255–9.CrossRefGoogle Scholar
  25. 25.
    Ambros-Rudolph CM, Mullegger RR, Vaughan-Jones SA, et al. The specific dermatoses of pregnancy revisited and reclassified: results of a retrospective two-center study on 505 pregnant patients. J Am Acad Dermatol. 2006;54:395–404.CrossRefGoogle Scholar
  26. 26.
    Lawley TJ, Stingl G, Katz SI. Fetal and maternal risk factors in herpes gestationis. Arch Dermatol. 1978;114:552–5.CrossRefGoogle Scholar
  27. 27.
    Hertz KC, Katz SI, Maize J, et al. Herpes gestationis: a clinicopathologic study. Arch Dermatol. 1976;112:1543–8.CrossRefGoogle Scholar
  28. 28.
    Barnadas MA, Rubiales MV, Gonzalez MJ, et al. Enzyme-linked immunosorbent assay (ELISA) and indirect immunofluorescence testing in a bullous pemphigoid and pemphigoid gestationis. Int J Dermatol. 2008;47:1245–9.CrossRefGoogle Scholar
  29. 29.
    Rodrigues Cdos S, Filipe P, Solana Mdel M, et al. Persistent herpes gestationis treated with high-dose intravenous immunoglobulin. Acta Derm Venereol. 2007;87:184–6.CrossRefGoogle Scholar
  30. 30.
    Kreuter A, Harati A, Breuckmann F, et al. Intravenous immune globulin in the treatment of persistent pemphigoid gestationis. J Am Acad Dermatol. 2004;51:1027–8.CrossRefGoogle Scholar
  31. 31.
    Hern S, Harman K, Bhogal BS, et al. A severe persistent case of pemphigoid gestationis treated with intravenous immunoglobulins and cyclosporin. Clin Exp Dermatol. 1998;23:185–8.CrossRefGoogle Scholar
  32. 32.
    Gan DC, Welsh B, Webster M. Successful treatment of a severe persistent case of pemphigoid gestationis with antepartum and postpartum intravenous immunoglobulin followed by azathioprine. Australas J Dermatol. 2012;53:66–9.CrossRefGoogle Scholar
  33. 33.
    Shornick JK, Black MM. Fetal risks in herpes gestationis. J Am Acad Dermatol. 1992;26:63–8.CrossRefGoogle Scholar
  34. 34.
    Al-Mutairi N, Sharma AK, Zaki A, et al. Maternal and neonatal pemphigoid gestationis. Clin Exp Dermatol. 2004;29:202–4.CrossRefGoogle Scholar
  35. 35.
    Shornick JK, Black MM. Secondary autoimmune diseases in herpes gestationis (pemphigoid gestationis). J Am Acad Dermatol. 1992;26:563–6.CrossRefGoogle Scholar
  36. 36.
    Chang SE, Kim HH, Choi JH, Sung KJ, Moon KC, Koh JK. Impetigo herpetiformis followed by generalized pustular psoriasis: more evidence of same disease entity. Int J Dermatol. 2003;42(9):754–5.CrossRefGoogle Scholar
  37. 37.
    Lotem M, Katzenelson V, Rotem A, Hod M, Sandbank M. Impetigo herpetiformis: a variant of pustular psoriasis or a separate entity? J Am Acad Dermatol. 1989;20:338–41.CrossRefGoogle Scholar
  38. 38.
    Winton GB, Lewis CW. Dermatoses of pregnanacy. J Am Acad Dermatol. 1982;6:977–98.CrossRefGoogle Scholar
  39. 39.
    Hellreich P. The skin changes of pregnancy. Cutis. 1974;13:82–6.Google Scholar
  40. 40.
    Sasseville D, Wilkinson RD, Schnader JY. Dermatoses of pregnancy. Int J Dermatol. 1981;20:223–41.CrossRefGoogle Scholar
  41. 41.
    Baker H, Ryan TJ. Generalized pustular psoriasis. A clinical and epidemiological study of 104 cases. Br J Dermatol. 1968;80:771–93.CrossRefGoogle Scholar
  42. 42.
    Sugiura K, Nakasuka A, Kono H, Kono M, Akiyama M. Impetigo herpetiformis with IL36RN mutations in a Chinese patient: a founder haplotype of c.115+6T>C in East Asia. J Dermatol Sci. 2015;79:319–20.CrossRefGoogle Scholar
  43. 43.
    Sugiura K, Oiso N, Iinuma S, Matsuda H, Minami-Hori M, Ishida-Yamamoto A, Kawada A, Iizuka H, Akiyama M. IL36RN mutations underlie impetigo herpetiformis. J Invest Dermatol. 2014;134:2472–4.CrossRefGoogle Scholar
  44. 44.
    Soutou B, Aractingi S. Skin disease in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2015;29:732–40.CrossRefGoogle Scholar
  45. 45.
    Eudy SF, Baker GF. Dermatopathology for the obstetrician. Clin Obstet Gynecol. 1990;33:728–37.CrossRefGoogle Scholar
  46. 46.
    Bozdag K, Ozturk S, Ermete M. A case of recurrent impetigo herpetiformis treated with systemic corticosteroids and narrowband UVB. Cutan Ocul Toxicol. 2012;31:67–9.CrossRefGoogle Scholar
  47. 47.
    Shaw CJ, Wu P, Sriemevan A. First trimester impetigo herpetiformis in multiparous female successfully treated with oral cyclosporine. BMJ Case Rep. 2011;12:bcr0220113915.Google Scholar
  48. 48.
    Luewan S, Sirichotiyakul S, Tongsong T. Recurrent impetigo herpetiformis successfully treated with methotrexate: a case report. J Obstet Gynaecol Res. 2011;37:661–3.CrossRefGoogle Scholar
  49. 49.
    Saito-Sasaki N, Izu K, Sawada Y, Hino R, Nakano R, Shimajiri S, Nishimura I, Nakamura H, Sugiura K, Nakamura M. Impetigo herpetiformis complicated with intrauterine growth restriction treated successfully with granulocyte and monocyte apheresis. Acta Derm Venereol. 2017;97:410–1.CrossRefGoogle Scholar
  50. 50.
    Hayashi RH. Bullous dermatoses and prurigo of pregnancy. Clin Obstet Gynecol. 1990;33:746–53.CrossRefGoogle Scholar
  51. 51.
    Barker B. Ernest Besnier 1831-1909. Arch Dermatol Syphilol. 1929;20:95–9.CrossRefGoogle Scholar
  52. 52.
    Nurse DS. Prurigo of pregnancy. Australas J Dermatol. 1968;9:258–67.CrossRefGoogle Scholar
  53. 53.
    Cohen LM. Dermatoses of pregnancy. West J Med. 1998;169:223–4.PubMedPubMedCentralGoogle Scholar
  54. 54.
    Black MM. Prurigo of pregnancy, papular dermatitis of pregnancy, and pruritic folliculitis of pregnancy. Semin Dermatol. 1997;8:23–5.Google Scholar
  55. 55.
    Roger D, Vaillant L, Fignon A, et al. Specific pruritic diseases of pregnancy. A prospective study of 3192 pregnant women. Arch Dermatol. 1994;130:744–9.CrossRefGoogle Scholar
  56. 56.
    Black MM, Stephens C. The specific dermatoses of pregnancy, the British perspective. Adv Dermatol. 1989;7:105–27.Google Scholar
  57. 57.
    Wilkinson SM, Buckler H, Wilkinson N. Androgen levels in pruritic folliculitis of pregnancy. Clin Exp Dermatol. 1995;20:234–6.CrossRefGoogle Scholar
  58. 58.
    Dacus JV. Pruritus in pregnancy. Clin Obstet Gynecol. 1990;33:738–45.CrossRefGoogle Scholar
  59. 59.
    Tunzi M, Gray GR. Common skin conditions during pregnancy. Am Fam Physician. 2007;75:211–8.Google Scholar
  60. 60.
    Al-Fares SI, Jones SV, Black MM. The specific dermatoses of pregnancy: a re-appraisal. J Eur Acad Dermatol Venereol. 2001;15:197–206.CrossRefGoogle Scholar
  61. 61.
    Zoberman E, Farmer ER. Pruritic folliculitis of pregnancy. Arch Dermatol. 1981;117:20–2.CrossRefGoogle Scholar
  62. 62.
    Alcalay J, Ingber A, Hazaz B, et al. Linear IgM dermatosis of pregnancy. J Am Acad Dermatol. 1988;18:412–5.CrossRefGoogle Scholar
  63. 63.
    Helm TN, Valenzuela R. Continuous dermoepidermal junction IgM detected by immunofluorescence: a report of nine cases. J Am Acad Dermatol. 1992;26:203–6.CrossRefGoogle Scholar
  64. 64.
    Dahdah MI, Kibbi AG. Less well-defined dermatoses of pregnancy. Clin Dermatol. 2006;24:118–21.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Arieh Ingber
    • 1
  1. 1.Department of DermatologyHadassah University Hospital, Hebrew UniversityJerusalemIsrael

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