Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary 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.) Graphic Jump LocationView Full Size|Favorite Figure|Download Slide (.ppt) +++ 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, ... GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessDermatologyDxRx 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessDermatologyDxRx Full Site: One-Year Individual Subscription $995 USD Buy Now View All Subscription Options