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Hassan I, Bashir S, Taing S. A clinical study of the skin changes in pregnancy in kashmir valley of north India: a hospital based study. Indian J Dermatol 2015; 60:28-32. [PMID: 25657393 PMCID: PMC4318058 DOI: 10.4103/0019-5154.147782] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Pregnancy is associated with multiple skin changes, most of which are physiological in nature, being the direct result of expected modifications of the hormonal, vascular, metabolic or immunologic status in pregnant females. Pregnancy however is also associated with certain pruritic eruptions, which not only cause distress to the pregnant female, but may influence the fetal outcome as well. Objective: The objective of this study was to determine the pattern of skin changes associated with pregnancy and to identify the various clinical types of pregnancy specific dermatoses (PSDs). Materials and Methods: The study was a cross sectional study carried out at the out-patient Department of Gynecology and obstetrics of our hospital. A total of 650 pregnant females, irrespective of their parity and gestational age were screened for the presence of any dermatological complaint. Results: The age of the study population ranged from 17 to 39 years (mean age: 24 years). The study population included 272 (42%) primigravidae and 378 (58%) multigravidae. Physiological skin changes of pregnancy were seen in all patients, out of which linea nigra was the most common change, seen in 520 (80%) cases. Specific dermatoses of pregnancy were seen in 32 (4.9%) cases, which included (in the decreasing order of frequency) prurigo of pregnancy (50% cases), intrahepatic cholestasis of pregnancy (25% cases), polymorphic eruption of pregnancy (22% cases) and pemphigus gestationis (3% cases). Conclusion: Skin changes were seen in 100% of pregnant females in this study, the major proportion being formed by physiological skin changes of pregnancy though PSDs were also seen in a significant number.
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Affiliation(s)
- Iffat Hassan
- Department of Dermatology, STD, Leprosy, Government Medical College, Srinagar (University of Kashmir), Jammu and Kashmir, India ; Department of Gynaecology and Obstetrics, Government Medical College, Srinagar (University of Kashmir), Jammu and Kashmir, India
| | - Safia Bashir
- Department of Dermatology, STD, Leprosy, Government Medical College, Srinagar (University of Kashmir), Jammu and Kashmir, India ; Department of Gynaecology and Obstetrics, Government Medical College, Srinagar (University of Kashmir), Jammu and Kashmir, India
| | - Shahnaaz Taing
- Department of Dermatology, STD, Leprosy, Government Medical College, Srinagar (University of Kashmir), Jammu and Kashmir, India ; Department of Gynaecology and Obstetrics, Government Medical College, Srinagar (University of Kashmir), Jammu and Kashmir, India
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Kasielska-Trojan A, Sobczak M, Antoszewski B. Risk factors of striae gravidarum. Int J Cosmet Sci 2015; 37:236-40. [DOI: 10.1111/ics.12188] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 11/14/2014] [Indexed: 11/30/2022]
Affiliation(s)
- A. Kasielska-Trojan
- Plastic, Reconstructive and Aesthetic Surgery Clinic Medical University of Lodz Kopcinskiego 22; Lodz 90-153 Poland
| | - M. Sobczak
- Obstetrics Out-patient Department; Polish Mother's Memorial Hospital- Research Institute; Rzgowska 281/289 Lodz 93-338 Poland
| | - B. Antoszewski
- Plastic, Reconstructive and Aesthetic Surgery Clinic Medical University of Lodz Kopcinskiego 22; Lodz 90-153 Poland
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Lu Y, Wang SJ, Li X, Hu L, Zhang WJ, Li W. Infantile hemangioma-like vascular lesion in a 26-year-old woman after abortion. Dermatology 2014; 229:169-73. [PMID: 25342210 DOI: 10.1159/000360817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 02/21/2014] [Indexed: 11/19/2022] Open
Abstract
A 26-year-old woman (G2P1A1) presented with a 5-week history of multiple red marks on her body after a therapeutic abortion. A physical examination found 15 palpable red marks on her head, neck, chest, arms and legs. Proliferating endothelial cells, which expressed CD31, CD34, von Willebrand factor, but not Glut-1 and merosin, were observed in the lesional area by histopathological analyses. Histocompatibility antigen typing of 2 lesions was identical to a sample from peripheral blood. Accelerated regression was observed in 2 lesions treated by intralesional injection of betamethasone, while spontaneous regression was observed within 9 months in the remaining lesions without any treatment. Rapid growth, spontaneous regression and histological analyses in this case support the diagnosis of 'infantile hemangioma-like vascular lesion'.
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Affiliation(s)
- Yang Lu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Ramot Y. Cutaneous Vascular Changes in Pregnancy. CURRENT DERMATOLOGY REPORTS 2014. [DOI: 10.1007/s13671-014-0080-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Zinkhan M, Stang A, Jöckel KH, Marr A, Bornfeld N, Schmidt-Pokrzywniak A. Having children, social characteristics, smoking and the risk of uveal melanoma: a case-control study. Ophthalmic Epidemiol 2014; 20:360-8. [PMID: 24229069 DOI: 10.3109/09286586.2013.844842] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE We analyzed data from the Risk Factors for Uveal Melanoma (RIFA) study to evaluate possible associations between uveal melanoma risk and having children, socioeconomic level and smoking. METHODS The RIFA study was a German case-control study conducted from September 2002 to March 2005. The study population consisted of 455 incident uveal melanoma patients (20-74 years of age) and 827 matched (age, sex, region of residence) population controls. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using conditional logistic regression. RESULTS Women with children showed an increased OR (1.59, 95% CI 0.95-2.66) for uveal melanoma development compared to women without children. We estimated decreased ORs for subjects with higher socioeconomic level compared to the lowest status (upper secondary school leaving certificate: OR 0.68, 95% CI 0.49-0.94; higher education: OR 0.60, 95% CI 0.38-0.96). Ever smokers showed an OR of 1.19 (95% CI 0.92-1.55) compared to never smokers. CONCLUSION The observed association between lower socioeconomic level and increased odds for uveal melanoma possibly represents a higher occupational uveal melanoma risk for occupational categories that are usually associated with lower socioeconomic status. Concerning having children and uveal melanoma development, we hypothesize that the observed association is mediated through alpha-melanocyte-stimulating hormone, a hormone that increases during pregnancy and is linked to pigmentation alterations in pregnant women.
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Affiliation(s)
- Melanie Zinkhan
- Institute of Clinical Epidemiology, Medical Faculty, Martin-Luther-University of Halle-Wittenberg , Halle , Germany
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Abstract
The specific dermatoses of pregnancy represent a diverse group of intensely pruritic dermatoses, occurring only in the puerperal state. The relative rarity of these conditions, the often variable clinical appearance, and the lack of definitive diagnostic tests have led to confusion regarding the appropriate diagnosis and management of the specific dermatoses of pregnancy. Herein we review the clinical characteristics, diagnosis and treatment of five dermatoses occurring during pregnancy: pruritic urticarial papules and plaques of pregnancy, atopic eruption of pregnancy, pemphigoid gestationis, intrahepatic cholestasis of pregnancy, and pustular psoriasis of pregnancy.
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Affiliation(s)
- Stephanie Lehrhoff
- The Ronald O. Perelman Department of Dermatology, New York University, New York, New York 10016, USA.
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Jeon IK, On HR, Oh SH, Hann SK. Three cases of pruritic urticarial papules and plaques of pregnancy (PUPPP) treated with intramuscular injection of autologous whole blood. J Eur Acad Dermatol Venereol 2014; 29:797-800. [PMID: 24593765 DOI: 10.1111/jdv.12414] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 01/25/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pruritic urticarial papules and plaques of pregnancy (PUPPP), also known as polymorphic eruption of pregnancy, is a common and benign but exceedingly uncomfortable dermatosis of pregnancy. Investigation of new treatment options has been limited by patient concerns about the negative fetal effects of medication. OBJECTIVE To assess the efficacy of intramuscular injection of autologous whole blood (AWB) for treatment of PUPPP. METHODS This is a retrospective descriptive case series of three patients with PUPPP, all of whom were treated with intramuscular injection of AWB. RESULTS All patients showed good responses to intramuscular injection of AWB, tolerated the treatment, and there were no adverse effects to the patients or their babies. CONCLUSION AWB may be an alternative treatment option for patients with PUPPP who are worried about the risk of medication use during pregnancy or breastfeeding. Whole blood collected from the patient's own body may be preferable to foreign medications. Future investigation into the exact mechanism with controlled clinical studies using a large number of patients will be necessary to provide supporting evidence for this potential treatment.
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Affiliation(s)
- I K Jeon
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
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58
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Kroumpouzos G. Specific dermatoses of pregnancy: advances and controversies. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.10.59] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Gleicher N. Graft-versus-host disease and immunologic rejection: implications for diagnosis and treatments of pregnancy complications. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.3.1.37] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Abstract
Pregnancy is associated with hormonal, metabolic, immunologic, haemodynamic and vascular changes which produce physiological and pathological cutaneous manifestations. Most skin disorders during pregnancy represent physiological changes. The specific dermatoses of pregnancy are disease entities almost exclusively related to the pregnancy or the postpartum period. Some dermatoses characteristically improve or exacerbate during pregnancy. Dermatoses of pregnancy can potentially be a serious risk to the foetus. Although the foetal outcome is almost always favourable, early diagnosis and prompt treatment are essential. Use of any medication during pregnancy should be carefully considered, and as few medications as possible should be administered. In this review, the authors discuss the various dermatoses of pregnancy in detail, based on novel classification, aetiology and pathogenesis, diagnostic approach, disease course, prognosis, foetal risk and therapy.
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Affiliation(s)
- Agnes Sziray
- Miskolci Semmelweis Kórház és Egyetemi Oktatókórház Bőrgyógyászati Osztály Miskolc Jókai Mór u. 4. 3525
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Hassan A, Mohammad L, Nassar A, Abd-Elazeem M, Abaza M. Immunohistochemical study of estrogen and androgen receptors in skin tags. J Microsc Ultrastruct 2013. [DOI: 10.1016/j.jmau.2013.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Kar S, Krishnan A, Shivkumar PV. Pregnancy and skin. J Obstet Gynaecol India 2012; 62:268-75. [PMID: 23730028 DOI: 10.1007/s13224-012-0179-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 04/08/2012] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Skin changes occur in about 90 % pregnant women in one form or the other. The various skin changes maybe either physiological (hormonal), changes in pre-existing skin diseases or development of new pregnancy-specific dermatoses. All of these dermatoses can be attributed to the profound hormonal, vascular, metabolic, and immunological changes occurring during pregnancy. CLASSIFICATION Pregnancy-specific dermatoses have now been classified into dermatoses which are definitively associated and dermatoses with uncertain association with pregnancy. Though most of these skin dermatoses are benign and resolve in postpartum period, a few can risk fetal life and require antenatal surveillance. Most of the dermatoses of pregnancy can be treated conservatively but a few require intervention in the form of termination of pregnancy. CONCLUSION Careful history taking and examination will help us to identify each condition clinically and appropriate management can be instituted for the well-being of the mother and the fetus.
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Affiliation(s)
- Sumit Kar
- Department of Dermatology, Venereology & Leprosy, Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sevagram, Wardha, Maharashtra 442012 India
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Rutnin S, Nguyen JV, Miller CJ, DeHoratius D, Rubin AI. Pregnancy-associated acquired arteriovenous malformation of the nail unit: a novel cause of localized erythronychia. J Cutan Pathol 2012; 39:1030-4. [PMID: 22882235 DOI: 10.1111/j.1600-0560.2012.01966.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 05/01/2012] [Accepted: 06/01/2012] [Indexed: 11/30/2022]
Abstract
Localized longitudinal erythronychia describes a solitary red streak limited to a single nail unit. Localized longitudinal erythronychia can be caused by both benign and malignant entities. Most commonly, the cause is a benign process, such as an onychopapilloma. We report a case of an acquired subungual arteriovenous malformation that presented as localized longitudinal erythronychia during pregnancy. To our knowledge, this is the first report of localized longitudinal erythronychia arising from a pregnancy-associated arteriovenous malformation of the nail unit.
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Affiliation(s)
- Suthinee Rutnin
- Department of Dermatology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA 19104-6142, USA
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Abstract
Pemphigoid gestationis (PG) or herpes gestationis is a rare autoimmune subepidermal blistering disorder associated with pregnancy. The condition typically develops during the second or third trimester of pregnancy, but has been rarely reported in the first trimester and postpartum period. Here, we report a case of PG that presented for the first time in the postpartum period, associated with a low birth weight baby.
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Affiliation(s)
- Sumi Thomas
- Department of Dermatology, Government Medical College, Calicut, Kerala, India
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Abstract
Atopic dermatitis (AD) is the most common pregnancy dermatosis. This evidence-based review article provides an evaluation of AD in gestation. Our literature search revealed 4 epidemiologic studies on AD in pregnancy, and a total of 55 articles that provide the basis for this review. The limitations of epidemiologic studies included herein are critically reviewed. The management of AD in gestation is reviewed with an emphasis on drug safety. Further studies are required to determine whether it is the intrinsic ("nonallergic" or "atopiform dermatitis") and/or extrinsic (IgE-associated) AD that is affected by pregnancy, and to establish the postpartum prognosis of "new atopic dermatitis" (AD presenting for the first time in pregnancy). A revision of the diagnostic criteria will allow a more accurate confirmation of the prevalence of AD, and especially "new atopic dermatitis," in pregnancy as well as differentiation of AD from specific dermatoses of pregnancy, such as prurigo and pruritic folliculitis. Addressing the above issues and unraveling the etiopathogenesis of AD in pregnancy will help clarify a suggested overlap with the above specific dermatoses.
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69
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Abstract
Some aspects regarding the etiology and the nosologic classification of various pregnancy dermatoses are highly controversial. While some authors highlight the existence of premises allowing several skin disorders to be re-grouped within broader disease concepts, others underline the absence of clear, undisputed etiopathogenetic data that could support such classifications. This review exhaustively analyzes the various pregnancy dermatoses (pemphigoid gestationis, intrahepatic cholestasis of pregnancy, impetigo herpetiformis, polymorphic eruption of pregnancy, and the papular dermatoses of pregnancy [prurigo of pregnancy, pruritic folliculitis of pregnancy, and the new classification, atopic eruption of pregnancy]) in an attempt to shed light over this confusing and disputed domain, while subsequently offering an algorithmic approach to their diagnosis and management. While for pemphigus gestationis, intrahepatic cholestasis of pregnancy, and impetigo herpetiformis, specific diagnostic tests such as histopathology, immunofluorescence, or laboratory investigations will confirm the diagnosis, the identification of the other types of pregnancy dermatoses is based only on clinical criteria. In this context, the review argues for the inclusion of the whole group represented by the papular dermatoses of pregnancy within the broad spectrum of polymorphic eruption of pregnancy, separating each of these entities by focusing on their onset: early-onset polymorphic eruption of pregnancy (comprising prurigo of pregnancy, pruritic folliculitis of pregnancy, and atopic eruption of pregnancy) and late-onset polymorphic eruption of pregnancy. In light of the same practical approach guiding it, the review provides updated treatment strategies for each of these conditions.
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Affiliation(s)
- Maria-Magdalena Roth
- Department of Dermatology, "Elias" University Emergency Hospital, Bucharest, Romania.
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70
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Abstract
BACKGROUND Ritodrine hydrochloride, a β2-adrenergic agonist, has been used for the treatment of pre-term labor as a relatively safe agent, although tolerable side-effects have been occasionally reported. OBJECTIVE The purpose of this study was to assess our clinical experience of skin eruptions caused by ritodrine. METHODS Fourteen pregnant women with pruritic skin eruptions associated with the administration of ritodrine for pre-term labor were examined in Saitama Medical Center Hospital between 2005 and 2008. RESULTS Patients included both primigravidas and multigravidas. Their mean age was 33.7 years (range: 27-41 years). Almost all subjects were in the third trimester of pregnancy. Skin eruptions occurred 7-27 days (mean: 14.9 days) after the start of intravenous or oral ritodrine. In eight patients, the eruption occurred after an increase in the dose of the drug. The reaction was characterized by a pruritic, erythematous, papular eruption, mainly distributed on the abdomen and upper extremities. Lymphocyte transformation tests for ritodrine were positive in five of the eight patients. CONCLUSIONS Ritodrine-induced, erythematous, papular eruption probably occurs more frequently than has been previously estimated. An immunologic mechanism may play a role in the development of this eruption caused by ritodrine, although the reaction is somewhat dependent on the dose.
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Affiliation(s)
- Yoshihiro Sato
- Department of Dermatology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
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[Physiologic skin changes in pregnancy]. Presse Med 2010; 40:e17-21. [PMID: 20843649 DOI: 10.1016/j.lpm.2010.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Revised: 03/08/2010] [Accepted: 04/09/2010] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Pregnancy is a period of hormonal, immunological, metabolic and vascular changes. Some of them are considered to be physiologic, but others are real diseases specific or not of pregnancy. The aim of our study is to present the epidemiological and clinical physiologic dermatological changes of pregnancy. METHODS We present a transversal monocentric study. One hundred pregnant women attending the department of dermatology of the La Rabta hospital were enrolled. Systematic detailed cutaneous examination was performed by a dermatologist to look for a physiologic skin changes. RESULTS The mean age was 29 years [20-46 years]. Pigmentary changes were the most preponderant (93%), dominated by the areolar region pigmentation (77%). The glandular changes were noted in 75% of cases. The vascular modifications were observed in 77% of pregnant women. Of these, gingival hyperemia was the most common (46%). Others cutaneous changes were less frequent (stria distensae 45%, nevi changes 35%, molluscum gravidarum 10%). DISCUSSION The physiologic cutaneous changes during pregnancy are numerous. Our study confirms the frequency and the variability of these modifications. The pigmentary changes were the most common finding.
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Abstract
The skin changes in pregnancy can be either physiological (hormonal), changes in pre-existing skin diseases or development of new pregnancy specific dermatoses. Pregnancy-specific skin dermatoses include an ill-defined heterogeneous group of pruritic skin eruptions which are seen only in pregnancy. These include atopic eruption of pregnancy, polymorphic eruption of pregnancy, pemphigoid gestationis and intrahepatic cholestasis of pregnancy. Atopic eruption of pregnancy is the most common of these disorders. Most skin eruptions resolve postpartum and require only symptomatic treatment. Antepartum surveillance is recommended for patients with pemphigoid gestationis and intrahepatic cholestasis of pregnancy as they carry fetal risk. This article deals with the classification, clinical features and treatment of the specific dermatoses of pregnancy.
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Al Shobaili HA, Hamed HO, Al Robaee A, Alzolibani AA, Amin AF, Ahmad SR. Obstetrical and fetal outcomes of a new management strategy in patients with intra-hepatic cholestasis of pregnancy. Arch Gynecol Obstet 2010; 283:1219-25. [PMID: 20521062 DOI: 10.1007/s00404-010-1506-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 05/03/2010] [Indexed: 12/27/2022]
Abstract
PURPOSES To determine the incidence, obstetrical, and fetal complication rates of intrahepatic cholestasis of pregnancy (ICP) in patients managed expectantly to 40-weeks gestation. METHODS In a prospective cohort study conducted between February 2008 and January 2010, a total of 21,960 pregnant women in Qassim Region of Saudi Arabia were screened for ICP using specific criteria for diagnosis. The course of pregnancy was monitored to 40-weeks gestation or spontaneous onset of labor, whichever comes first. The measured outcomes were compared with a cross-matched group of healthy pregnant women. Continuous variables were analyzed with t test, while χ(2) test was used for comparing percentages. RESULTS The incidence of ICP was 0.35% (76/21,960). There was no significant difference between groups in gestational age at delivery, preterm labor, intrauterine fetal death, cesarean section, or respiratory distress syndrome. There was significantly higher intrapartum non-reassuring fetal heart rate patterns and meconium-stained amniotic fluid in ICP group (P < 0.01 and <0.0001, respectively). CONCLUSIONS The incidence of ICP in this region is low compared to worldwide range. Expectant management to 40-weeks gestation is associated with obstetrical and fetal outcomes comparable to normal pregnancy; however, intrapartum fetal asphyxia is more likely.
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Kenyon AP, Tribe RM, Nelson-Piercy C, Girling JC, Williamson C, Seed PT, Vaughan-Jones S, Shennan AH. Pruritus in pregnancy: a study of anatomical distribution and prevalence in relation to the development of obstetric cholestasis. Obstet Med 2010; 3:25-9. [PMID: 27582836 DOI: 10.1258/om.2010.090055] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2010] [Indexed: 12/27/2022] Open
Abstract
The main objective of this study was to determine the prevalence and anatomical distribution of pruritus in 6532 pregnant women from a UK antenatal population. Pregnant women attending and completing antenatal care at two general hospitals over a 12-month period were recruited and contacted on three occasions by post. Medical advice and a questionnaire detailing the nature and severity of their pruritus were included. Pruritus in pregnancy, as reported by questionnaire, affected approximately 23% of pregnancies (n = 1521/6532 women) and 1.6% (n = 25) of these women developed obstetric cholestasis (OC). Overall, 0.66% of the antenatal population (43/6532) had a clinical diagnosis of OC (95% CI: 0.48-0.89%). Itching unrelated to OC was most commonly reported to be worst on the abdomen (31%, 616/2014). Women with OC reported pruritus to be most severe on the palms and soles in 16% (4/25) and 'all over' in 24% (6/25) compared with 5% (54/1120) (P < 0.05) and 4% (42/1120, P < 0.0001) of those without OC. In conclusion, pruritus affected approximately one in four women and OC one in 135 women during the study period. Women whose pruritus is 'all over' or most severe on the 'palms or soles' may be at greater risk of the disease.
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Affiliation(s)
- A P Kenyon
- Maternal and Fetal Research Unit, Division of Reproduction and Endocrinology, King's College
| | - R M Tribe
- Maternal and Fetal Research Unit, Division of Reproduction and Endocrinology, King's College
| | - C Nelson-Piercy
- Maternal and Fetal Research Unit, Division of Reproduction and Endocrinology, King's College
| | | | | | - P T Seed
- Maternal and Fetal Research Unit, Division of Reproduction and Endocrinology, King's College
| | - S Vaughan-Jones
- Department of Dermatology, St Peter's Hospital Chertsey , Surrey , UK
| | - A H Shennan
- Maternal and Fetal Research Unit, Division of Reproduction and Endocrinology, King's College
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Guinot C, Cheffai S, Latreille J, Dhaoui MA, Youssef S, Jaber K, Nageotte O, Doss N. Aggravating factors for melasma: a prospective study in 197 Tunisian patients. J Eur Acad Dermatol Venereol 2010; 24:1060-9. [PMID: 20202051 DOI: 10.1111/j.1468-3083.2010.03592.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Melasma is a frequent cause of consultations at dermatology departments by dark-skinned patients in Tunisia. OBJECTIVE To investigate factors that influence melasma severity in a large Tunisian population. METHODS A total of 197 patients (188 women and 9 men), who attended Tunis Military Hospital for a consultation were included prospectively from August 2005 to August 2006. Disease severity was estimated using the Melasma Area and Severity Index (MASI). Aggravating factors were investigated using multiple logistic regressions. RESULTS Of the women included, 14% presented phototype III, 45% phototype IV and 41% phototype V; 76% presented a centrofacial melasma phenotype, 23% a malar and 1% a mandibular phenotype. About 60% developed melasma before thirty. Sun exposure was reported as a triggering factor by 51% of women and as an aggravating factor by 84%. Pregnancy was reported as an aggravating factor by 51% of women who had been pregnant, and oral contraceptive use reported by 38% of women exposed to oral contraceptives. The risk of severe melasma was about three times higher for women with age at onset under 30, phototype V and major lifetime sun exposure and about 8 times higher for women exposed to oral contraceptives. CONCLUSION This study identifies a number of factors associated with the severity of melasma. Further epidemiological studies in this type of population, in particular, to investigate triggering factors, are justified by the aesthetic damage caused by melasma in dark-skinned patients, lack of efficacy of existing treatments, non-compliance with photoprotection recommendations and the challenge of treatment.
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Affiliation(s)
- C Guinot
- Biometrics and Epidemiology Unit, CERIES, Neuilly sur Seine, France
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Goldenberg G, Krowchuk DP, Jorizzo JL. Successful treatment of a therapy‐resistant pyogenic granuloma with topical imiquimod 5% cream. J DERMATOL TREAT 2009; 17:121-3. [PMID: 16766338 DOI: 10.1080/09546630600552323] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A 58-year-old man was referred to our department for evaluation and treatment of a therapy-resistant pyogenic granuloma on his right third digit. This biopsy-confirmed lesion was unsuccessfully treated with shave excision and base electrocautery on two separate occasions before the patient presented to our clinic. After completing a 14-week course of twice-weekly imiquimod 5% topical application, this patient's pyogenic granuloma completely resolved. A satisfactory cosmetic outcome was also achieved, with virtually no scarring.
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Affiliation(s)
- Gary Goldenberg
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
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[Specific dermatoses of pregnancy--new classification and differential diagnosis]. MEDICINSKI PREGLED 2009; 61:586-90. [PMID: 19368277 DOI: 10.2298/mpns0812586m] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The specific dermatoses of pregnancy represent heterogeneous group of pruritic skin disorders that occur exclusively in pregnancy. SPECIFIC DERMATOSES OF PREGNANCY The updated classification proposed subdividing specific dermatoses of pregnancy into four main categories: 1. atopic eruption of pregnancy; 2. polymorphic eruption of pregnancy; 3. pemphigoid gestationis; 4. intrahepatic cholestasis of pregnancy. Severe pruritius, which is the main symptom in all 4 entities, can impair maternal quality of life. Significant maternal risks are not associated with specific dermatoses of pregnancy; however, pemphigoid gestationis and intrahepatic cholestasis of pregnancy are associated with fetal risks. CONCLUSION Pathognomonic laboratory tests are not available, except direct immunofluorescence which is diagnostic of pemphigoid gestationis and elevated serum level of bile acids of intrahepatic cholestasis of pregnancy. Characteristic clinical features provide discrimination between polymorphic eruption of pregnancy and atopic eruption of pregnancy.
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78
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Abstract
Palmar erythema (PE), an often overlooked physical finding, is due to several physiologic or systemic pathologic states. PE can exist as a primary physiologic finding or as a secondary marker of systemic pathology. Primary or physiologic PE can be due to heredity, occurs in at least 30% of pregnant women as a result of associated alterations in the function of the skin and its microvasculature, or may be a diagnosis of exclusion (i.e. idiopathic PE). Secondary PE from systemic pathology encompasses a wide range of disease states. Twenty-three percent of patients with liver cirrhosis, from varying causes, can manifest PE as a result of abnormal serum estradiol levels. Patients with a rare neonatal liver disease such as Wilson disease and hereditary hemochromatosis may exhibit PE along with the other systemic manifestations of the genodermatoses. PE has been reported to occur in >60% of patients with rheumatoid arthritis and is associated with a favorable prognosis. Up to 18% of patients with thyrotoxicosis and 4.1% of patients with diabetes mellitus can have PE. This cutaneous manifestation of diabetes occurs more often than the more classic diseases such as necrobiosis lipoidica diabeticorum (0.6%). PE can be seen in early gestational syphilis and among patients with human T-lymphotrophic virus-1-associated myelopathy. Drug-induced PE with hepatic damage has been documented with use of amiodarone, gemfibrozil, and cholestyramine, while topiramate and albuterol (salbutamol) have been reported to cause PE in the setting of normal liver function. Fifteen percent of patients with both metastatic and primary brain neoplasms may have PE. Increased levels of angiogenic factors and estrogens from solid tumors have been postulated as the cause of PE in such cases. Erythema ab igne can mimic PE, and patients with atopic diathesis are more likely to have PE than matched control subjects. Smoking and chronic mercury poisoning are environmental causes of PE.No treatment of primary PE is indicated. If medication is the cause of PE, the drug responsible should be discontinued if possible. Identification of PE related to underlying disorders should be followed by treatment of the underlying condition. In light of the numerous etiologies of PE, this article reviews the current literature and provides a framework to help guide the clinician in determining the cause of PE in patients presenting with this finding.
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Affiliation(s)
- Rocco Serrao
- Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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79
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Rader C, Piorkowski J, Bass DM, Babigian A. Epulis gravidarum manum: pyogenic granuloma of the hand occurring in pregnant women. J Hand Surg Am 2008; 33:263-5. [PMID: 18294552 DOI: 10.1016/j.jhsa.2007.11.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Revised: 11/24/2007] [Accepted: 11/28/2007] [Indexed: 02/02/2023]
Abstract
Pyogenic granuloma, also known as lobular capillary hemangioma, is a benign vascular tumor of the skin and mucous membranes. Whereas the literature describes pyogenic granulomas of pregnancy as occurring mainly within the gingival or oral mucosa, we present 5 cases of a histologically confirmed pyogenic granuloma on the hands of gravid women, each with no history of antecedent trauma. These tumors failed to resolve spontaneously postpartum necessitating surgical removal. We propose the term epulis gravidarum manum to describe this skin lesion.
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Affiliation(s)
- Christine Rader
- University of Connecticut and Hartford Hospital, Hartford, CT, USA
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80
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Nading MA, Nanney LB, Boyd AS, Ellis DL. Estrogen receptor beta expression in nevi during pregnancy. Exp Dermatol 2008; 17:489-97. [PMID: 18177352 DOI: 10.1111/j.1600-0625.2007.00667.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Estrogen levels increase during pregnancy and clinical evidence has long suggested that melanocytes are estrogen-responsive. We hypothesized that nevi from pregnant patients would exhibit increased expression of estrogen receptor beta (ERbeta) and thus enhanced potential to respond to altered estrogen levels. Normal, dysplastic and congenital nevi (n = 212) were collected from pregnant and non-pregnant women ranging from 18 to 45 years of age. Immunohistochemical staining was performed on these nevi using antibodies specifically directed against estrogen receptor alpha (ERalpha) and ERbeta. ERalpha was not observed in any lesions; thus, ERbeta was the predominant estrogen receptor in melanocytic cells from all types of nevi. Enhanced positivity for ERbeta in normal nevi during pregnancy was noted, compared with non-pregnant controls including nevocytes residing in both the epidermal and dermal micro-environments (P = 0.005 and P = 0.001 respectively). Nevi with increasingly melanocytic atypia showed increased ERbeta in nevocytes nested within the epidermis. No additional increase in ERbeta in atypical nevi was observed during pregnancy. For normal and congenital nevi, regardless of pregnancy status, dermally associated nevocytes tended to have greater ERbeta immunoreactivity. Significant decreases in ERbeta immunoreactivity were observed in congenital nevi from pregnant women compared with normal and dysplastic nevi from pregnant women. Our data suggest that nevi possess the capacity to be estrogen-responsive. Factors such as pregnancy and degree of atypia are associated with enhanced ERbeta with the exception of congenital nevi where the melanocytes were unique in their response to pregnancy.
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Affiliation(s)
- Mary Alice Nading
- Department of Medicine, Division of Dermatology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
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81
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Ghali GE, Harris CM. Cosmetic surgery considerations in the female patient. Oral Maxillofac Surg Clin North Am 2007; 19:235-44, vii. [PMID: 18088881 DOI: 10.1016/j.coms.2007.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A greater number of women than men undergo facial cosmetic procedures. Oral and maxillofacial surgeons should have an in-depth knowledge of the physiologic and anatomic differences between the sexes with respect to surgical treatment options. Gender differences in regard to the planning and management of female cosmetic surgery patients are the focus of this article.
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Affiliation(s)
- G E Ghali
- Department of Oral and Maxillofacial-Head and Neck Surgery, Louisiana State University-Shreveport Medical Center, 1501 Kings Highway, Shreveport, LA 71111, USA.
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82
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Abstract
A 23-year-old woman presented to our polyclinic complaining of itching, generalized dermatitis, and jaundice. She was in her 31st gestational week and had developed pruritus and the dermatitis since the first month of pregnancy; her jaundice started about a month before presentation. Her history included similar complaints in a previous pregnancy, which resulted in premature birth of a baby with a permanent brain defect. One of her sisters had had jaundice and itching in her 27th gestational week and delivered a healthy baby; a second sister had experienced itching and dermatitis in her second trimester and delivered a healthy baby. Physical examination of the patient showed that her eyes were jaundiced (Figure 1); skin examination revealed generalized erythematous excoriated papules, symmetrically distributed all over her body (Figure 2 Figure 3). Laboratory analyses revealed the following results: leukocyte count, 14.30/mm(3) (3.8-10.3/mm(3)); erythrocyte sedimentation rate, 25 mm/h (<20 mm/h); aspartate aminotransferase, 44 U/L (5-40 U/L); alanine aminotransferase, 63 U/L (5-40 U/L); lactate dehydrogenase, 1158 U/L (220-450 U/L); total bilirubin, 6.88 mg/dL (<1.10 mg/dL); and direct bilirubin, 3.27 mg/dL (<0.35 mg/dL). Urinalysis results were positive for bilirubin and urobilinogen. Positive serologic findings included rubella immunoglobulin G, 93 AU/mL (<15) and cytomegalovirus, 188 AU/mL (<10); negative findings included herpes simplex virus type 2 and hepatitis. Histopathologic examination of material collected from the left breast via punch biopsy showed parakeratosis, acanthosis, and perivascular lymphocyte infiltration in dermal vessels. Treatment with 2 g/d cholestyramine and a topical corticosteroid was effective in the patient, who was diagnosed with intrahepatic cholestasis of pregnancy and prurigo of pregnancy based on the clinical, histopathologic, and laboratory findings. To the authors' knowledge, this is the first such reported case in the literature.
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Affiliation(s)
- Demet Cicek
- Department of Dermatology, Firat University Faculty of Medicine, Elazig, Turkey.
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83
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Hsu CK, Lee JYY, Yu CH, Hsu MML, Wong TW. Lip verrucous carcinoma in a pregnant woman successfully treated with carbon dioxide laser surgery. Br J Dermatol 2007; 157:813-5. [PMID: 17627786 DOI: 10.1111/j.1365-2133.2007.08078.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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84
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Zampino MR, Osti F, Corazza M, Virgili A. Prevalence of pityriasis versicolor in a group of Italian pregnant women. J Eur Acad Dermatol Venereol 2007; 21:1249-52. [PMID: 17894714 DOI: 10.1111/j.1468-3083.2007.02253.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although a predisposing role of pregnancy to Malassezia infections is referred, data on the prevalence of pityriasis versicolor (PV) in pregnant women are not available in literature. OBJECTIVE To investigate the frequency of PV during pregnancy, 60 pregnant women were clinically and microscopically investigated during and after pregnancy. RESULTS Fifty-two women completed all visits; three women were affected by PV at first or third trimester of pregnancy, and none at 6 months after delivery. Colonization due to Malassezia yeasts was very significantly (P < 0.01) or significantly increased (P < 0.05) at the third trimester and 6 months after delivery, respectively. No variation was observed between the end of pregnancy and the postpartum (P > 0.05). CONCLUSION Frequency of PV during pregnancy (5.7%) does not seem different from that reported in general population living in temperate climates (2-5%). However, higher degree of colonization by Malassezia resulted at the end of pregnancy and postpartum.
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Affiliation(s)
- M R Zampino
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Ferrara, Ferrara, Italy
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85
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Soliman MM, Ramadan SAR, Bassiouny DA, Abdelmalek M. Combined trichloroacetic acid peel and topical ascorbic acid versus trichloroacetic acid peel alone in the treatment of melasma: a comparative study. J Cosmet Dermatol 2007; 6:89-94. [PMID: 17524124 DOI: 10.1111/j.1473-2165.2007.00302.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Melasma is a common acquired hypermelanosis that is difficult to treat. Several chemical peeling agents were used in treatment of melasma. Topical vitamin C was also used with minimal side effects. AIM To compare the effect of 20% trichloroacetic acid (TCA) peel alone vs. 20% TCA peel combined with topical 5% ascorbic acid in cases of epidermal melasma. PATIENTS AND METHODS Thirty women with bilateral epidermal melasma (Fitzpatrick skin types III and IV) were divided into two groups (A and B, 15 patients each). Before therapy, digital photography and a melasma area and severity index (MASI) score were done for each patient. Groups A and B were primed for 2 weeks before TCA peel. Group B also applied 5% ascorbic acid topically once daily; 20% TCA peel was done for all patients weekly until clearance of melasma or for a maximum of six peels. Group B continued to use 5% ascorbic acid topically in between peels and during the 16-week follow-up period. Patients were assessed at the end of peeling sessions and at the end of follow-up by photography, MASI score, and a global evaluation by the patient. RESULTS Group B compared with group A showed a significant decrease in MASI score at the end of TCA peels (P < 0.001) and at the end of the 16-week follow-up period (P < 0.003). Global evaluation showed that 13 patients (87%) in group B improved or maintained their improvement compared with only 10 patients (67%) in group A. CONCLUSION Topical ascorbic acid combined with 20% TCA peel in melasma improves the results and helps in maintaining the response to therapy.
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Affiliation(s)
- Mohsen Mohamed Soliman
- The Department of Dermatology, Kasr El-Aini University Hospital, Cairo University, Cairo, Egypt
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86
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Giblin AV, Clover AJP, Athanassopoulos A, Budny PG. Pyogenic granuloma - the quest for optimum treatment: audit of treatment of 408 cases. J Plast Reconstr Aesthet Surg 2007; 60:1030-5. [PMID: 17478135 DOI: 10.1016/j.bjps.2006.10.018] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2006] [Accepted: 10/10/2006] [Indexed: 10/23/2022]
Abstract
Pyogenic granuloma is a common, acquired, benign vascular lesion of skin and mucous membranes which may occasionally present intravascularly or subcutaneously. Pyogenic granuloma occur in all age groups and although they may eventually regress, removal of unsightly, bleeding or uncomfortably positioned lesions is usually sought before this takes place. This is a retrospective study of 408 cases of pyogenic granuloma that were analysed by the Stoke Mandeville Histopathology laboratory between 1994 and 2004. This study was carried out to review the sex, age and anatomic distribution of the lesions and to assess the most successful form of treatment on the basis of recurrence risk and other measures such as aesthetic result, acceptability and appropriateness of the procedure with respect to the patient. There was a slight male preponderance especially among children. The exception to this was lesions on mucous membranes, which were more common in women. Head and neck was the most common anatomical location, in particular the cheek and intraoral locations. Fewest recurrences were noted following excision and direct closure although all techniques investigated showed an acceptably low recurrence rate. Whatever technique is used it must yield material for histopathological analysis to ensure the exclusion of differential diagnoses.
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Affiliation(s)
- A V Giblin
- Department of Plastic and Reconstructive Surgery, Stoke Mandeville Hospital, Mandeville Road, Aylesbury, Buckinghamshire HP21 8AL, UK.
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87
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Brightman L, Stefanato CM, Bhawan J, Phillips TJ. Third-trimester impetigo herpetiformis treated with cyclosporine. J Am Acad Dermatol 2007; 56:S62-4. [PMID: 17224395 DOI: 10.1016/j.jaad.2006.08.042] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Revised: 06/24/2006] [Accepted: 08/17/2006] [Indexed: 11/24/2022]
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88
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Abstract
SummaryThe oral health status of a hundred pregnant women and that of one hundred non-pregnant women attending an antenatal clinic and gynaecological clinic respectively at Korle Bu Teaching Hospital was assessed for some common oral pathologies. The doctors and other health personnel managing the pregnant women were also quizzed to ascertain knowledge of any of these conditions. The aim was to find out if any oral condition was particularly prevalent in the pregnant women but not in the non-pregnant women. Our study confirms that in these women, pregnancy has an effect on the oral health status. However this effect is more likely due to the physiological changes associated with pregnancy than any other specific factors. Some oral conditions already present may be influenced by the hormonal changes, which in some cases exacerbate or ameliorate minor oral pathologies. Our findings were similar to that in other studies. However health workers who deal with the pregnant women in these clinics are less aware of these conditions and hence do not usually give any advice.
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Affiliation(s)
- Bdrt Annan
- Department of Obstetric and Gynaecology, Korle Bu Teaching Hospital, Accra, Ghana
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89
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Zampino MR, Corazza M, Costantino D, Mollica G, Virgili A. Are melanocytic nevi influenced by pregnancy? A dermoscopic evaluation. Dermatol Surg 2007; 32:1497-504. [PMID: 17199661 DOI: 10.1111/j.1524-4725.2006.32362.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dermoscopic data of melanocytic nevi (MN) in pregnancy are very limited and related to small groups of women. OBJECTIVE This study systematically analyzes dermoscopic parameters in a wide series of MN during and after pregnancy. METHODS Eighty-six MN on the back of 47 women were studied. Dermoscopic parameters, total dermoscopic score (TDS) according to Stolz's ABCD rule, and the sizes of the nevi were evaluated over time. RESULTS Progressive lightening of the nevi resulted at the end of pregnancy (p<.05) and after delivery (p<.001). Pigment network showed a progressive reduction in prominence and thickness (end of pregnancy, p<.05; after delivery, p<.01). At the end of pregnancy, vessels increased (p<.05) and a higher TDS was observed, with a significant reduction in both after delivery (vessels, p<.05; TDS, p<.01). Area changes were not statistically significant. CONCLUSIONS At the end of pregnancy, both vascular structures and TDS increased. These modifications were transient as the nevi recovered their prior appearance after delivery. The results indicate that an intrinsic influence of pregnancy may induce structural modifications without influencing the size of the nevi. Behavioral factors during the observational period, like a reduced exposure to sunlight reported by most of the women, may have influenced other characteristics, like global pigmentation and pigment network. The authors thank the Fondazione Cassa di Risparmio di Ferrara for its financial support, which enabled them to acquire the instrumentation necessary for this study.
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Affiliation(s)
- Maria Rosaria Zampino
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Ferrara, Ferrara, Italy
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90
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Abstract
In humans, structural and functional changes attributable to aging are more visibly evident in the skin than in any other organ. Estrogens have significant effects on skin physiology and modulate epidermal keratinocytes, dermal fibroblasts and melanocytes, in addition to skin appendages including the hair follicle and the sebaceous gland. Importantly, skin aging can be significantly delayed by the administration of estrogen. This paper reviews the effects of estrogens on skin and the mechanisms by which estrogens can alleviate the changes due to aging that occur in human skin. The relevance of estrogen replacement therapy (HRT) in postmenopausal women and the potential value of selective estrogen receptor modulators (SERMs) as a therapy for diminishing skin aging are also highlighted.
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Affiliation(s)
| | - Julie Thornton
- Cutaneous Research, Medical Biosciences, School of Life Sciences, University of Bradford, Bradford, UK
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91
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92
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Abstract
Polymorphic eruption of pregnancy (PEP) is a benign, self-limiting, pruritic disorder of pregnancy, which usually affects the primigravida during the last trimester or immediately postpartum. Its pathogenesis is unclear and its clinical manifestations are variable, leading frequently to an incorrect diagnosis. In cases of PEP the histological findings are nonspecific and the laboratory results, including direct immunofluorescence (DIF) and indirect immunofluorescence (IIF), are negative. Polymorphic eruption of pregnancy is not associated with any fetal risk and symptomatic treatment is all that is usually required. In this review we present the clinical presentation of PEP and a differential diagnosis which defines PEP as a separate entity. We will also review all current data of possible etiologic factors, histologic and immunologic findings, prognosis and therapy.
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Affiliation(s)
- Haritini Petropoulou
- Department of Dermatology, University of Athens School of Medicine, Andreas Sygros Hospital for Skin and Venereal Diseases, Athens, Greece
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93
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Amitay-Layish I, David M, Kafri B, Barzilai A, Feinmesser M, Hodak E. Early-stage mycosis fungoides, parapsoriasis en plaque, and pregnancy. Int J Dermatol 2006; 46:160-5. [PMID: 17269968 DOI: 10.1111/j.1365-4632.2006.02963.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Non-Hodgkin's lymphoma (NHL) coincident with pregnancy is rare, and the literature regarding mycosis fungoides (MF), the most common primary cutaneous NHL, and pregnancy is strikingly sparse. The effect of pregnancy on MF, or on parapsoriasis en plaque (PPP), and the effect of these diseases on pregnancy, are still unknown. OBJECTIVE To study the effect of pregnancy on MF and PPP and the impact of these diseases on pregnancy. METHODS The files of the MF and PPP patients seen during the past 12 years in our department were reviewed to search for patients who had been pregnant during the course of their disease. RESULTS Nine women who met the study criteria were identified, seven with early-stage MF and two with PPP. A total of 12 pregnancies was recorded: nine in patients with MF and three in patients with PPP. In none of the patients was there any indication that pregnancy changed the course of MF or PPP. Of the 12 pregnancies, 11 were normal; one was naturally aborted. Two of the patients were treated with topical steroids during pregnancy. One patient was treated with narrow-band ultraviolet-B combined with topical steroids. The rest preferred to avoid any therapy. CONCLUSIONS Pregnancy appeared to have no impact on the course of early MF or PPP, and no adverse effect was noted on pregnancy. Further studies are needed to clarify the interplay between pregnancy and MF or PPP.
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Affiliation(s)
- Iris Amitay-Layish
- Department of Dermatology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
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94
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Abstract
Impetigo herpetiformis is a rare pustular disorder that occurs primarily in pregnancy and is often associated with hypocalcemia. The onset commonly presents in the last trimester of pregnancy; the condition may persist until delivery and it rarely continues in the postpartum period. There is an increase in morbidity and mortality for the mother and the fetus. As a result, immediate diagnosis and treatment is crucial. The purpose of this article is to delineate the clinical picture of this disease, its treatment, and the effect on the mother and the fetus.
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95
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Abstract
Miscellaneous groups of dermatoses are associated with pregnancy and affected by gestation, but they do not coincide with any known classifications. They are inflammatory in nature and include psoriasis, acne, hidradenitis suppurativa, atopic dermatitis, and erythema multiforme. Such dermatoses can either improve or worsen during pregnancy. This review focuses on the changes that can occur during the pregnant state.
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96
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Matz H, Orion E, Wolf R. Pruritic urticarial papules and plaques of pregnancy: polymorphic eruption of pregnancy (PUPPP). Clin Dermatol 2006; 24:105-8. [PMID: 16487883 DOI: 10.1016/j.clindermatol.2005.10.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The most commonly diagnosed pruritic dermatosis of pregnancy has a confusing nomenclature. The most commonly term used in the United States is pruritic urticarial papules and plaques of pregnancy (PUPPP), and in Great Britain, since 1982, polymorphic eruption of pregnancy. The etiology of PUPPP is still unknown. Placental products, hormonal alterations, and damage to connective tissue with subsequent conversion of nonantigenic molecules to antigenic ones, have been proposed as possible causes. The maternal and fetal prognosis is excellent. Treatment consists of topical or oral corticosteroids. Delivery does not usually provide relief of symptoms.
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Affiliation(s)
- Hagit Matz
- Dermatology Unit, Kaplan Medical Center, 76100 Rechovot, Israel
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97
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Abstract
Over the past several decades, many specific and nonspecific dermatoses of pregnancy have been described. The lack of a well-defined clinical and histological features as well as reproducibility in some of these entities has led to confusing reports in the literature. In this review article, an account of these nonspecific dermatoses of pregnancy will be presented in an attempt to shed light on their nosology and to better categorize them in view of the recent literature findings.
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Affiliation(s)
- Maurice J Dahdah
- Department of Dermatology, American University of Beirut Medical Center, Riad El Solh, Beirut 1107-2020, Lebanon
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98
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Abstract
The endocrinologic, immunological, and vascular changes that occur during pregnancy are far-reaching. These systemic factors produce profound local impact on the physiology and pathology of the oral cavity, vagina, and vulva. Physiological changes can be expected and tolerable or of such severity that they are viewed as pathological. Existing disease can be exacerbated and dermatoses specific to pregnancy can erupt. Each of these conditions can pose potentially challenging treatment considerations.
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Affiliation(s)
- Rochelle R Torgerson
- Department of Dermatology, Mayo Clinic College of Medicine, Rochester MN 55905, USA.
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99
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Abstract
Pregnancy affects all organ systems in the body, including the skin. Some skin changes are physiological, whereas others such as the dermatoses of pregnancy are pathological. Dermatologists regularly encounter pregnant patients, and the identification of normal skin changes and their differentiation from disease states are essential to insure the well-being of both mother and fetus. This review discusses the physiological skin changes in pregnancy, including alterations in pigmentation, hair, nail, and connective tissue, as well as vascular and hematologic changes and modulation of glandular function.
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Affiliation(s)
- Maya M Muallem
- Department of Dermatology, American University of Beirut Medical Center, Beirut 113-6044, Lebanon
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100
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Monteagudo B, Suárez O, Rodríguez I, Ginarte M, León A, Pereiro M, Pereiro M. [Longitudinal melanonychia in pregnancy]. ACTAS DERMO-SIFILIOGRAFICAS 2006; 96:550. [PMID: 16476297 DOI: 10.1016/s0001-7310(05)73134-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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