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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.

Keywords

Bullous Pemphigoid Intrahepatic Cholestasis Erythema Multiforme Systemic Glucocorticoid Cicatricial Pemphigoid 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 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.PubMedGoogle Scholar
  2. 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.PubMedCrossRefGoogle Scholar
  3. 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.PubMedCrossRefGoogle Scholar
  4. 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.PubMedCrossRefGoogle Scholar
  5. 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.PubMedCrossRefGoogle Scholar
  6. 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.PubMedCrossRefGoogle Scholar
  7. Bemanian MH, Gharagozlou M, Farashahi MH, Nabavi M, Shirkhoda Z. Autoimmune progesterone anaphylaxis. Iran J Allergy Asthma Immunol. 2007;6(2):97–9.PubMedGoogle Scholar
  8. 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.PubMedCrossRefGoogle Scholar
  9. 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.PubMedGoogle Scholar
  10. Chang AL, Agredano YZ, Kimball AB. Risk factors associated with striae gravidarum. J Am Acad Dermatol. 2004;51(6):881–5.PubMedCrossRefGoogle Scholar
  11. Cocuroccia B, Gisondi P, Gubinelli E, Girolomoni G. Autoimmune progesterone dermatitis. Gyne-col Endocrinol. 2006;22(1):54–6.CrossRefGoogle Scholar
  12. 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.PubMedCrossRefGoogle Scholar
  13. 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.PubMedCrossRefGoogle Scholar
  14. Dedecker F, Graesslin O, Quereux C, Gabriel R. Autoimmune progesterone dermatitis: A rare pathology. Eur J Obstet Gynecol Reprod Biol. 2005;123, 121CrossRefGoogle Scholar
  15. 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.PubMedCrossRefGoogle Scholar
  16. Errickson C V, Matus NR. Skin disorders of pregnancy. Am Fam Physician. 1994;49(3):605–10.PubMedGoogle Scholar
  17. Esteve E. Les dermatoses aux oestrogènes et à la progesterone: une nosologie en devenir. Editorial. Ann Dermatol Venereol. 1998;125:484–5.PubMedGoogle Scholar
  18. 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.PubMedCrossRefGoogle Scholar
  19. Ghosh D, Sengupta J. Recent developments in endocrinology and paracrinology of blastocyst implantation in the primate. Hum Reprod Update. 1998;4(2):153–68.PubMedCrossRefGoogle Scholar
  20. Grin CM, Driscoll MS, Grant-Kels JM. The relationship of pregnancy, hormones, and melanoma. Semin Cutan Med Surg. 1998;17(3):167–71.PubMedCrossRefGoogle Scholar
  21. 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.PubMedGoogle Scholar
  22. Hertl M. (ed). Autoimmune diseases of the skin: pathogenesis, diagnosis, management. 2nd Ed., Springer, New York, 2005Google Scholar
  23. 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.PubMedGoogle Scholar
  24. Holmes RC, Black MM. The specific dermatoses of pregnancy. J Am Acad Dermatol. 1983 Mar;8(3):405–12.PubMedCrossRefGoogle Scholar
  25. Jolliffe DS, Sim-Davis D. Cicatricial pemphigoid in a young girl: report of a case. Clin Exp Der-matol. 1977;2(3): 281–4.PubMedCrossRefGoogle Scholar
  26. Kakarla N, Zurawin RK. A case of autoimmune progesterone dermatitis in an adolescent female. J Pediatr Adolesc Gynecol. 2006;19(2):125–9.PubMedCrossRefGoogle Scholar
  27. Kayisli UA, Guzeloglu-Kayisli O, Arici A. Endocrine-immune interactions in human endometrium. Ann N Y Acad Sci. 2004;1034:50–63.PubMedCrossRefGoogle Scholar
  28. Koch CA, Platt JL. T cell recognition and immunity in the fetus and mother. Cell Immunol. 2007;248(1):12–7.PubMedGoogle Scholar
  29. Kumari R, Jaisankar TJ, Thappa DM. A clinical study of skin changes in pregnancy. Indian J Der-matol Venereol Leprol. 2007;73(2):141.Google Scholar
  30. 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.PubMedCrossRefGoogle Scholar
  31. Laskaris G, Angelopoulos A. Cicatricial pemphigoid: direct and indirect immunofluorescent studies. Oral Surg Oral Med Oral Pathol. 1981;51(1): 48–54.PubMedCrossRefGoogle Scholar
  32. Lawley TJ, Hertz KC, Wade TR, Ackerman AB, Katz SI. Pruritic urticarial papules and plaques of pregnancy. JAMA. 1979;241(16):1696–9.PubMedCrossRefGoogle Scholar
  33. Lea RG, Sandra O. Immunoendocrine aspects of endometrial function and implantation. Reproduction. 2007;134(3):389–404.PubMedCrossRefGoogle Scholar
  34. 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.PubMedCrossRefGoogle Scholar
  35. Muzaffar F, Hussain I, Haroon TS. Physiologic skin changes during pregnancy: a study of 140 cases. Int J Dermatol. 1998;37(6):429–31.PubMedCrossRefGoogle Scholar
  36. Nilles M, Weyers W, Gründer K. Die PUPPP Dermatose. Hautarzt. 1989;40(9):586–8.PubMedGoogle Scholar
  37. 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.PubMedCrossRefGoogle Scholar
  38. Oskay T, Kutluay L, Kaptanoglu A, Karabacak O. Autoimmune progesterone dermatitis. Eur J Dermatol. 2002;12(6):589–91.PubMedGoogle Scholar
  39. 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.CrossRefGoogle Scholar
  40. Rampen FH. Sex differences in survival from cutaneous melanoma. Int J Dermatol. 1984;23(7): 444–52.PubMedGoogle Scholar
  41. 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.PubMedCrossRefGoogle Scholar
  42. 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.PubMedCrossRefGoogle Scholar
  43. 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.CrossRefGoogle Scholar
  44. 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.PubMedCrossRefGoogle Scholar
  45. Sheiner E, Ohel I, Levy A, Katz M. Pregnancy outcome in women with pruritus gravidarum. J Reprod Med. 2006;51(5):394–8.PubMedGoogle Scholar
  46. Sherard GB 3rd, Atkinson SM Jr. Focus on primary care: pruritic dermatological conditions in pregnancy. Obstet Gynecol Surv. 2001;56(7):427–32.PubMedCrossRefGoogle Scholar
  47. Silipo V, De Simone P, Mariani G, Buccini P, Ferrari A, Catricala C. Malignant melanoma and pregnancy. Melanoma Res. 2006;16(6):497–500.PubMedCrossRefGoogle Scholar
  48. 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.PubMedCrossRefGoogle Scholar
  49. Steen VD. Pregnancy in scleroderma. Rheum Dis Clin North Am. 2007;33(2):345–58, vii.PubMedCrossRefGoogle Scholar
  50. 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.PubMedGoogle Scholar
  51. Thomas RG, Liston WA. Clinical associations of striae gravidarum. J Obstet Gynaecol. 2004;24(3): 270–1.PubMedCrossRefGoogle Scholar
  52. Tunzi M, Gray GR. Common Skin Conditions During Pregnancy. Fam Physician. 2007;75:211–8Google Scholar
  53. Uhlin SR. Pruritic urticarial papules and plaques of pregnancy. Involvement in mother and infant. Arch Dermatol. 1981;117(4):238–9.PubMedCrossRefGoogle Scholar
  54. 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.PubMedCrossRefGoogle Scholar
  55. Weatherhead S, Robson SC, Reynolds NJ. Management of psoriasis in pregnancy. BMJ. 2007;334(7605): 1218–20.PubMedCrossRefGoogle Scholar
  56. 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.PubMedCrossRefGoogle Scholar
  57. Wilkinson SM, Beck MH, Kingston T P. Progesterone-induced urticaria —need it be autoimmune? Br J Dermatol. 1995;133:792–4.PubMedCrossRefGoogle Scholar
  58. Wintzen M, Goor-van Egmond MB, Noz KC. Autoimmune progesterone dermatitis presenting with purpura and petechiae. Clin Exp Dermatol. 2004;29(3):316.PubMedCrossRefGoogle Scholar
  59. 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.PubMedGoogle Scholar
  60. 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.PubMedCrossRefGoogle Scholar
  61. 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.PubMedGoogle Scholar

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