Recent developments in the specific dermatoses of pregnancy

Abstract

During pregnancy, the mother undergoes changes to sustain and enable normal growth and development of the fetus. Common physiological changes include linea nigra, fibroepithelial polyps, striae, spider angioma, palmar erythema and pruritis gravidarum. However, there are some changes that are purely pathological, and these are termed the pregnancy-specific dermatoses (PSDs). The PSDs occur during pregnancy or in the immediate postpartum period. They do not include the various benign conditions or pre-existing dermatoses and tumours that may present or worsen with pregnancy. They do include a number of distinct and identifiable conditions: atopic eruption of pregnancy (AEP), polymorphic eruption of pregnancy (PEP), intrahepatic cholestasis of pregnancy (ICP) and pemphigoid gestationis (PG). These are a heterogeneous group of skin conditions characterized by pruritis and inflammatory changes. In addition, pruritis gravidarum is sometimes considered pathophysiological and thus part of this group, rather than a physiological process. Each of these conditions has a distinct, but not fully understood, pathogenesis. The mechanisms leading to PSD may be a reflection on the hormonal and immunological changes associated with pregnancy. AEP and PEP are benign conditions, and although they can cause distress to the mother, they are otherwise minor. However, ICP and PG are more serious conditions, and both carry the potential for serious risks to both the mother and the fetus. Thus, the pathophysiology of these latter two conditions is considered in more detail in the following article.

Dermatological Diseases During Pregnancy

“…10 In the present study patients presented in the second and third trimester with increased levels of serum aminotransferases and bile acids, thus confirming other reports. 3,10,11 Incidence of sexually transmitted disease was 10.5% in our study. Condyloma acuminatum was the commonest sexually transmitted disease, seen in 12 patients (6%), 4 patients were seropositive for VDRL without any symptomatic disease.…”

Molecular Diagnosis in Autoimmune Skin Blistering Conditions

“…The immunopathological findings, which are similar to those of BP, allow PG to be distinguished from other pregnancy dermatoses, such as from pruritic urticarial papules and plaques of pregnancy, prurigo of pregnancy, allergic contact dermatitis, and drug eruptions [109-111]. The diagnosis of PG is basically made by demonstrating a pemphigoid in a pregnant patient.…”

Gestational pemphigoid

“…The most important differential diagnosis alternatives for PG are the other specific dermatoses of pregnancy which include atopic eruption of pregnancy (AEP), polymorphic eruption of pregnancy (PEP) and intrahepatic cholestasis of pregnancy (ICP) [6,36–40]. AEP is the most common pregnancy-specific skin disease, which typically appears in the first and second trimesters [40].…”

“…AEP is the most common pregnancy-specific skin disease, which typically appears in the first and second trimesters [40]. About 20% of the patients with AEP have a pre-existing atopic dermatitis with a typical clinical picture, whereas the remaining 80% present widespread eczematous changes or papular lesions and have no previous history of atopic eczema or have been symptomless since childhood [31].…”

“…Similar to PG, PEP symptoms usually start on the abdomen, but PEP lesions typically spare the umbilical region. ICP, which is associated with significant fetal risks, can present in the last trimester with pruritus, and thus it should be considered in differential diagnosis of PG [40]. Patients with ICP do not have primary skin lesions, but due to severe pruritus and scratching may develop secondary excoriations or even prurigo nodularis-like changes, usually on the extremities [31].…”