Pregnancy Dermatoses
Nathan W Rojek, MD
Assistant Professor of Dermatology
UC Irvine School of Medicine
Objectives
• List the dermatoses of pregnancy
• Compare and contrast the clinical presentations of the different pregnancy dermatoses
• Identify the treatment options for each specific condition
• Recognize which pregnancy dermatoses confer a risk to the fetus
Pemphigoid Gestationis (PG) is a rare, pruritic, autoimmune bullous disease that typically develops during late pregnancy or immediately post-partum
PG is caused by IgG1 autoantibodies targeting a transmembrane hemidesmosomal protein
Performing a biopsy for direct immunofluorescence is essential to confirm the diagnosis of PG
The primary goals of treatment are to relieve pruritus and suppress blister formation
Mild Cases
• Potent topical steroids plus: – Emollients (petrolatum)
– Systemic antihistamines
Moderate-to-Severe Cases
• Systemic steroids – 0.5mg/kg prednisone daily
Most disease activity spontaneously remits during the weeks to months following delivery
• OCPs induce flares and/or recurrences in 25-50% of patients
• Likely to recur in future pregnancies → earlier onset & more severe course
• ↑ risk of developing Graves disease in future
PG increases the risk of prematurity and small-for-gestational age neonates
Polymorphic eruption of pregnancy (PEP) is a common, pruritic, condition of unknown etiology that typically develops during
late pregnancy or immediately post-partum
PEP has nonspecific skin biopsy findings, negative immunofluorescence, and normal labs
PEP is self-limited and without serious sequelae, so the majority of patients require only topical steroids and oral antihistamines
PEP usually does not recur and has no maternal or fetal risks
Intrahepatic cholestasis of pregnancy (ICP) is rare and presents as pruritus without primary skin lesions with onset during 3rd trimester
ICP is a result of genetically-linked, hormone-dependent, reversible cholestasis
Elevated total serum bile acid levels are diagnostic for ICP
Ursodeoxycholic acid (UDCA) is the treatment for ICP
• Safe for mother & fetus
• 15mg/kg po daily started ASAP and continued until delivery
• Goal is normalization of serum bile acid levels
Pruritus typically persists until delivery and then resolves spontaneously within days
• 45-70% of patients get recurrence with another pregnancy
• OCPs routinely induce recurrence
ICP is associated with multiple maternal and fetal risks
Maternal Risks
• Steatorrhea
• Vitamin K deficiency
• Intra- and postpartum hemorrhage
Fetal Risks
• Prematurity (20-60%)
• Intrapartum fetal distress (20-30%)
• Fetal loss (1-2%)
Atopic eruption of pregnancy (AEP) is the most common pruritic disorder during pregnancy and 75% of cases begin before 3rd trimester
AEP occurs due to the normal pregnancy-induced immune shift towards a dominant Th2 response
AEP has histologic changes typical of eczematous conditions, negative immunofluorescence, and ↑ serum IgE in up to 70% of patients
AEP has no serious sequelae, so the majority of patients require only topical steroids and emollients
Mild Cases
• Topical steroids plus: – Emollients (petrolatum)
– Systemic antihistamines
Moderate-to-Severe Cases
• Narrow-band UVB
Maternal and fetal prognoses are excellent, though recurrences in subsequent pregnancies are common
Objectives
• List the dermatoses of pregnancy
• Compare and contrast the clinical presentations of the different pregnancy dermatoses
• Identify the treatment options for each specific condition
• Recognize which pregnancy dermatoses confer a risk to the fetus
Thanks for listening! Any questions?