Dermatoses of Pregnancy - Clues to Diagnosis, Fetal Risk and Therapy

Abstract

The specific dermatoses of pregnancy represent a heterogeneous group of pruritic skin diseases that have been recently reclassified and include pemphigoid (herpes) gestationis, polymorphic eruption of pregnancy (syn. pruritic urticarial papules and plaques of pregnancy), intrahepatic cholestasis of pregnancy, and atopic eruption of pregnancy. They are associated with severe pruritus that should never be neglected in pregnancy but always lead to an exact work-up of the patient. Clinical characteristics, in particular timing of onset, morphology and localization of skin lesions are crucial for diagnosis which, in case of pemphigoid gestationis and intrahepatic cholestasis of pregnancy, will be confirmed by specific immunofluorescence and laboratory findings. While polymorphic and atopic eruptions of pregnancy are distressing only to the mother because of pruritus, pemphigoid gestationis may be associated with prematurity and small-for-date babies and intrahepatic cholestasis of pregnancy poses an increased risk for fetal distress, prematurity, and stillbirth. Corticosteroids and antihistamines control pemphigoid gestationis, polymorphic and atopic eruptions of pregnancy; intrahepatic cholestasis of pregnancy, in contrast, should be treated with ursodeoxycholic acid. This review will focus on the new classification of pregnancy dermatoses, discuss them in detail, and present a practical algorithm to facilitate the management of the pregnant patient with skin lesions.

Case for diagnosis

“…1,2 PG typically develops in the second or third trimester of pregnancy, with an abrupt onset, but may appear any time during pregnancy or even in the immediate postpartum period. Severe pruritus is followed by the appearance of erythematous, urticarial papules and plaques that progress to tense vesicles and blisters.…”

A view of the problem of pregnancy-specific skin dermatoses. Part I

“…Например, при доминировании Th 1 -иммунного ответа (Th 1 -ассоциированные заболевания, напри-мер, псориаз) состояние больной улучшается, а по-сле беременности обостряется. При доминировании же Th 2 -иммунного ответа (Th 2 -ассоциированные за-болевания, например, герпетиформное импетиго, красная волчанка) состояние больной, напротив, ухудшается, иногда генерализуется [1,5].…”

“…При ГБ мишенью циркулирующих антител (подкласс IgG-1) становятся так называе-мый тенон-коллагеновый (NC16A) домен (пузыро-образование) БПАГ-2 (антиген буллезного пемфи-гоида-2; гликопротеин гемидесмосом дермоэпидер-мального соединения базального слоя эпидермиса с молекулярным весом в 180 кD), антигены хорион-ного и амнионного эпителия плаценты класса МНС-II (экспрессия приводит к аллогенной им-мунной реакции с матриксными антигенами пла-центы), а также антигены HLA-DR3 и HLA-DR4 [1,14,29,31].…”

“…Изменяется также эластичность кожи (стрии беременности), развиваются сосудистые изменения (эритема ладо-ней, паукообразная ангиома, гемангиомы, варикоз-ный синдром) [1][2][3][4][5].…”

Update on dermatoses of pregnancy

“…The rash resolves spontaneously about 4–6 weeks after initial onset 27 . Given the self‐limiting nature of the disease and lack of risk to the fetus, treatment is aimed at providing relief for the mother by attempting to control the pruritus and skin lesions with topical corticosteroids 28 . In severe cases, systemic corticosteroids are effective.…”