Skip to Main Content

COMMON SKIN CHANGES RELATED TO PREGNANCY

  • Hyperpigmentation of nipples, external genitalia

  • Linea nigra: midline pigmentary demarcation line on abdomen

  • Melasma: ill-defined pigmentation of cheeks, forehead

  • Striae: start reddish, become whitish, redness may be improved faster by pulsed dye laser, but otherwise that and other treatments unproven to have long-term benefit

  • Vascular lesions: varicosities, pyogenic granuloma

  • Increased or changing nevi, melanoma: unclear if truly increased over controls

  • Telogen effluvium typically starts 3 months after delivery

PRURITUS GRAVIDARUM

  • This is itching without rash (up to 14% of all pregnancies)

  • Potential intrahepatic cholestasis of pregnancy should be investigated in these patients, but this occurs in only 1 to 2% of all pregnancies, clinical jaundice in only 0.02% of pregnancies

  • Elevated liver function tests and serum bile acid levels may occur

  • Elevated glutathione S-transferase alpha (GSTA), a specific marker of hepatocellular integrity, identifies women with intrahepatic cholestasis and distinguishes them from those with benign pruritus gravidarum

  • Reported increases in rates of premature delivery and perinatal mortality appear to be restricted to those in whom frank clinical jaundice develops

  • Recurs in 50% of pregnancies

  • Treatment: phenobarbital, cholestyramine, (ursodeoxycholic acid controversial but advocated by some)

PRURITIC URTICARIAL PAPULES AND PLAQUES OF PREGNANCY (PUPPP), POLYMORPHOUS ERUPTION OF PREGNANCY (PEP)

  • The term PUPPP seems to be preferred in the United States and PEP in Europe (FIG. 21-1)

  • Polymorphous eruption with papules, plaques, urticarial lesions

  • The most common of the pregnancy rashes (0.6% of all pregnancies)

  • Onset in abdominal striae is common, then commonly spreads to abdomen, buttocks, thighs

  • Spongiosis may occur and cause confusion with pemphigoid gestationis, then immunofluorescence biopsy may be needed, since pemphigoid gestationis possibly may cause increased fetal morbidity or mortality, unlike PUPPP

  • Intensely pruritic, like most of these pregnancy rashes

  • Primagravids mostly, does not recur with subsequent pregnancies

  • Increased incidence of twins, rapid maternal weight gain

  • Usually third trimester

  • Biopsy not very specific: perivascular lymphocytes with eosinophils, edema, sometimes with spongiosis or parakeratosis

FIGURE 21-1

Pruritic urticarial papules and plaques of pregnancy (PUPPP). Note accentuation of rash in striae. (Used with permission from Dr. Ronald Rapini.)

PEMPHIGOID GESTATIONIS (HERPES GESTATIONIS)

  • The term pemphigoid gestationis is preferred by many because "herpes gestationis" causes confusion with herpes virus infection and its implications (FIG. 21-2)

  • Onset second or third trimester

  • Papules, urticarial plaques, vesicles, bullae

  • Often develops around umbilicus and extremities, later spreading to trunk, palms, and soles. Usually spares face and mucous membranes

  • Autoimmune disease similar to bullous pemphigoid (but linear C3 more often seen at dermal-epidermal junction zone than IgG). In both diseases the linear band is found in the epidermal side (roof) of the subepidermal blister

  • Increased HLA-DR3, DR4, B8

  • Circulating IgG4 autoantibodies in the blood are called herpes gestationis factor, avidly fixes complement to ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.