- 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.
KeywordsBullous Pemphigoid Intrahepatic Cholestasis Erythema Multiforme Systemic Glucocorticoid Cicatricial Pemphigoid
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