Prurigo of pregnancy: An appropriate term for cases not associated with atopy

Abstract

Rudder and colleagues have written an informative review on pruritus in pregnancy that includes a discussion about pregnancyspecific skin conditions such as atopic eruption of pregnancy (AEP). 1 AEP, an umbrella entity based on atopic background in women, comprises eczema in pregnancy, prurigo of pregnancy (PP), and pruritic folliculitis of pregnancy. Nevertheless, several aspects of AEP have been challenged, including the use of serum IgE elevation as a diagnostic criterium, which Rudder et al. acknowledge, and the presence of atopy in many PP women. 2 The largest prospective study on pregnancy dermatoses to date did not confirm an association of PP with atopy, 3 and an Indian study found a history of atopy in only 3 of 27 women with PP. 4 My group published recently a series of 20 PP cases that were not associated with atopic background (defined as personal or family history of atopy). 5 The eruption showed typical clinical PP features could persist until delivery, and did not recur postpartum. 5 It started in the late second to early third trimester (median gestational age: 27.5 weeks) while AEP has been reported before the third trimester in 75% of women. 1 Comorbidities unrelated to atopy, such as psychiatric disease (20%), were noted in the series. 5 Based on the above, the presence of atopic background has not been confirmed in a significant percentage of PP women. The PP group is likely heterogeneous and multiple etiopathogenetic pathways may be involved. 5 Most importantly, the AEP label to a PP case in a woman without an atopic history may lead to biased counseling about a woman's genetic predisposition that can give women the impression that they have a genetically determined skin disease. I suggest not labeling as AEP but keeping the term PP for those PP eruptions in women without atopic background.

Dermatoses of Pregnancy: Overview of Presentation, Treatment and Outcome

“…There are ongoing debates regarding the inclusion of pruritic folliculitis of pregnancy (PFP) and prurigo of pregnancy (PP) in the categorization of AEP. Some experts view them as distinct entities (24,25). PFP was initially identified in 1981 by Zoberman and Farmer (26).…”

Update on specific dermatoses of pregnancy

“…There are controversies about including PFP and PP in AEP. Some authors consider them to be separate entities [9][10][11][12][13]15 . PFP, described in 1981 by Zoberman and Famer, constitutes an erythematous papular, monomorphic eruption found in the second and third trimesters of pregnancy 28 with spontaneous regression after delivery 12 .…”

“…AEP can be considered another specific dermatosis. However, several authors propose that PFP and PP continue to be contemplated until further studies are conducted to clarify this heterogeneous group of dermatoses [9][10][11][12][13] . Table 1 summarizes the SDP reviewed in this article.…”

Impetigo herpetiformis: A rare pregnancy-specific dermatosis

“…Impetigo herpetiformis (IH) is a rare form of pustular pregnancy dermatosis, a group of disorders which also includes atopic eruption of pregnancy (AEP), prurigo of pregnancy (patients without atopic predisposition should be labelled prurigo of pregnancy than AEP), 1 polymorphic eruption of pregnancy (PEP), pemphigoid gestationis (PG), and intra-hepatic cholestasis of pregnancy (ICP). IH is classified as a subtype of generalised pustular psoriasis occurring exclusively during pregnancy.…”