1
|
Xie F, Agrawal S, Johnson EF, Wieland CN, Davis DMR, Theiler RN, Lehman JS. Updates on the dermatopathology of pregnancy-associated skin conditions. Hum Pathol 2023; 140:173-195. [PMID: 37209919 DOI: 10.1016/j.humpath.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/15/2023] [Indexed: 05/22/2023]
Abstract
Pathologists provide valuable input in the dermatological care of pregnant patients in various contexts. This article provides dermatopathology updates on cutaneous changes associated with pregnancy, organized based on the following classification system: physiological skin changes in pregnancy, specific dermatoses of pregnancy, dermatoses modified in pregnancy, and skin neoplasms in pregnancy. Awareness of the impact of pregnancy on the skin by pathologists is important, as this is an opportunity to contribute to diagnostic precision in this patient population.
Collapse
Affiliation(s)
- Fangyi Xie
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Shruti Agrawal
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Emma F Johnson
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Carilyn N Wieland
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Dawn Marie R Davis
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Regan N Theiler
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Julia S Lehman
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
| |
Collapse
|
2
|
Parfene CG, Bohiltea RE, Mihai BM, Grigoriu C, Margaritescu I, Chirita AD, Zugravu CA, Pelinescu-Onciul D. Influence of pemphigoid gestationis on pregnancy outcome: A case report and review of the literature. Exp Ther Med 2021; 23:23. [PMID: 34815775 DOI: 10.3892/etm.2021.10945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/29/2021] [Indexed: 11/06/2022] Open
Abstract
Pemphigoid gestationis is considered to be a rare pregnancy exclusive bullous disease, which modifies the course of the pregnancy, with difficulties in the management of the pruritus and skin lesions as well as a possible change in the neonatal outcome. Differential diagnosis of skin lesions and pruritus in pregnancy is challenging, and complementary investigations such as skin biopsy or laboratory tests are indispensable. The correct diagnosis and proper treatment could change the natural course of a pregnancy at risk and could improve maternal and fetal morbidity. We present the case of a patient with pemfigoid gestationis with the aim to highlight: i) the management of this pregnancy-associated skin disorder which transfers this pregnancy into a category of high obstetrical risk pregnancy; ii) the particularities of the course of the pregnancy; and iii) the importance in the differential diagnosis of pregnancy dermatoses. The particularity of this case of pemphigoid gestationis was the acute fetal distress in the absence of intrauterine growth restriction that is frequently found in this pathology, and the management of a rare pregnancy skin condition that currently has no standard treatment.
Collapse
Affiliation(s)
| | - Roxana Elena Bohiltea
- Department of Obstetrics and Gynecology, Life Memorial Hospital, 012244 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Bianca Margareta Mihai
- Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Corina Grigoriu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Irina Margaritescu
- Department of Pathology, Onco Team Diagnostic, 030138 Bucharest, Romania
| | - Aurel Doru Chirita
- Department of Dermatology, 'Carol Davila' Central Military University Emergency Hospital, 010825 Bucharest, Romania
| | - Corina Aurelia Zugravu
- Department of Food Hygiene and Nutrition, 'Carol Davila' University of Medicine and Pharmacy, 050463 Bucharest, Romania
| | | |
Collapse
|
3
|
Ravelli FN, Goldust M, Kroumpouzos G. Assessment of prurigo of pregnancy in patients without atopic background. Int J Womens Dermatol 2020; 6:384-389. [PMID: 33898704 PMCID: PMC8060660 DOI: 10.1016/j.ijwd.2020.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/12/2020] [Accepted: 06/24/2020] [Indexed: 11/19/2022] Open
Abstract
Background Prurigo of pregnancy (PP), a specific pregnancy dermatosis, has been associated with atopic background in the patient and/or the patient's family. However, this association was not validated in some studies, and cases without atopic background have been reported. Objective This study aimed to evaluate the clinical features of PP not related to atopic background and search for comorbid conditions in medical and obstetric records. Methods In this case series, patients with typical PP presentation (i.e., pruritic, discrete papulonodules on the extensor surfaces of the extremities) diagnosed at the dermatology clinics of tertiary referral hospitals were evaluated. The exclusion criteria included missing historical data, inadequate follow-up, laboratory test results suggestive of other pruritic conditions, history of atopic disease, and family history of atopy. Clinical and laboratory data including course, response to treatment, serum total immunoglobulin E level, and comorbidities in the medical and obstetric history were collected. Results Twenty patients developed PP predominantly during the late second or early third trimester. Nine patients reported that itching developed first, versus 10 patients who reported that lesions started first (one patient was uncertain about onset). There was no recurrence postpartum (mean postpartum follow-up, 17 months). Serum total immunoglobulin E level was elevated in 3 of 14 patients tested (21.4%). Obstetric history (n = 12) included polymorphic eruption of pregnancy (16.6%), PP (16.6%), and gestational pruritus (8.3%). Two of 20 patients (10%) had a history of pruritic skin condition (prurigo nodularis and pruritus of unclear etiology) while not pregnant. Medical history (n = 20) included psychiatric disease (20%) (obsessive compulsive disorder and anxiety), hypothyroidism (10%), and obesity (10%). Conclusion PP can develop in patients without an atopic background. This finding should be considered when classifying specific pregnancy dermatoses. A thorough medical and family history with a focus on atopy should be obtained from every patient with a gestational eruption, and patients should be counseled accordingly.
Collapse
Affiliation(s)
| | - Mohamad Goldust
- Department of Dermatology, University of Rome Guglielmo Marconi, Rome, Italy
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island, United States
- Department of Dermatology, Medical School of Jundiaí, Jundiaí, São Paulo, Brazil
- Corresponding author.
| |
Collapse
|
4
|
Abstract
The specific dermatoses of pregnancy represent a heterogeneous group of inflammatory skin diseases related to pregnancy and/or the postpartum period. A clinically relevant classification has been well established over the past 10 years and includes pemphigoid gestationis, polymorphic eruption of pregnancy, intrahepatic cholestasis of pregnancy, and atopic eruption of pregnancy. The hallmark of all four entities is severe pruritus that is accompanied by characteristic skin changes. While some of these dermatoses are distressing only to the mother because of pruritus, others may be associated with significant fetal risks. Early diagnosis and prompt treatment are therefore essential. In this review, we discuss in detail pemphigoid gestationis, polymorphic and atopic eruptions of pregnancy whereas intrahepatic cholestasis of pregnancy is discussed in a separate article (Kremer A, Ständer S, DOI 10.1007/s00105-016-3923-y ). Furthermore, we present a helpful algorithm for diagnosis and management of pruritus in pregnancy.
Collapse
Affiliation(s)
| | - M Sticherling
- Hautklinik, Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Deutschland
| |
Collapse
|
5
|
Fernandes LB, Amaral WND. Clinical study of skin changes in low and high risk pregnant women. An Bras Dermatol 2016; 90:822-6. [PMID: 26734862 PMCID: PMC4689069 DOI: 10.1590/abd1806-4841.20153570] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 01/14/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND During pregnancy there is immunological, metabolic, endocrine and vascular changes responsible for physiological and pathological skin changes. OBJECTIVES determine the prevalence of specific physiological changes and pregnancy, comparing the period of gestation of their appearances and compare type of prenatal care as the skin changes. METHODS A cross-sectional study with 905 pregnant women. RESULTS The prevalence of physiological skin changes was 88.95% and the most common was pigment. The prevalence of specific dermatoses was 8.72% and atopic eruption was the most common. CONCLUSION Physiological changes were seen more in the 3rd quarter, as well as the specific dermatoses. No statistical difference in prenatal low risk compared to high risk was observed, whereas the cutaneous physiological changes and specific pregnancy dermatoses.
Collapse
|
6
|
Prurigo, pruritic folliculitis, and atopic eruption of pregnancy: Facts and controversies. Clin Dermatol 2016; 34:392-400. [DOI: 10.1016/j.clindermatol.2016.02.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
7
|
Danesh M, Pomeranz MK, McMeniman E, Murase JE. Dermatoses of pregnancy: Nomenclature, misnomers, and myths. Clin Dermatol 2016; 34:314-9. [PMID: 27265068 DOI: 10.1016/j.clindermatol.2016.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The most recent reclassification of dermatoses of pregnancy includes polymorphic eruption of pregnancy, atopic eruption of pregnancy, and pemphigoid gestationis; intrahepatic cholestasis of pregnancy, strictly not a dermatosis, was included in specific dermatoses of pregnancy for working purposes. Another dermatosis, pustular psoriasis of pregnancy, could be included for similar reasons. The nomenclature of these pregnancy-specific eruptions has been revised several times, generating potential confusion among practitioners. Clouding the picture further are misnomers that have been used to describe dermatoses of pregnancy. In addition, several cutaneous conditions that are associated with, but not specific to, pregnancy, have been misunderstood, which has resulted in certain myths among patients and physicians. In this contribution, we describe how the nomenclature of each dermatosis of pregnancy has evolved to fit the current classification scheme. We then identify several misnomers that have generated confusion within the scheme. Finally, we debunk several myths that have developed around cutaneous conditions outside of this scheme, in both mother and newborn.
Collapse
Affiliation(s)
- Melissa Danesh
- Department of Dermatology, University of California School of Medicine, San Francisco, California
| | - Miriam Keltz Pomeranz
- The Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, New York, New York
| | - Erin McMeniman
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Australia; Dermatology Research Centre, The University of Queensland School of Medicine, Brisbane, Australia
| | - Jenny E Murase
- Department of Dermatology, University of California School of Medicine, San Francisco, California; Department of Dermatology, Palo Alto Foundation Medical Group, Mountain View, California.
| |
Collapse
|
8
|
Histopathological diagnosis of atopic eruption of pregnancy and polymorphic eruption of pregnancy: a study on 41 cases. Am J Dermatopathol 2015; 36:812-21. [PMID: 25243396 DOI: 10.1097/dad.0000000000000067] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The specific dermatoses of pregnancy represent a recently reclassified heterogeneous group of pruritic inflammatory skin diseases unique to pregnancy that include pemphigoid gestationis, polymorphic eruption of pregnancy (PEP), intrahepatic cholestasis of pregnancy, and atopic eruption of pregnancy (AEP). Among them, PEP and AEP are the most frequent ones. We performed a histopathological study of a series of PEP and AEP patients (n = 41). Twenty-two patients had PEP that started in the third trimester in 16 (73%) patients and postpartum in 6 (27%) patients. Histopathology revealed a superficial or superficial and deep perivascular dermatitis with eosinophils in all biopsies and signs of a lymphocytic vasculitis in 5 (23%) cases. Epidermal changes, including epidermal hyperplasia, spongiosis, and parakeratosis, occurred in 8 cases, in particular in elder lesions. Nineteen patients had AEP that started earlier [less than third trimester, 14 (74%) patients; third trimester, 5 (26%) patients]. Clinically, 5 (26%) patients showed eczematous lesions, 7 (37%) papular lesions, 3 (16%) presented both eczematous and prurigo lesions, and 4 (21%) experienced exacerbation of preexisting atopic dermatitis. Histopathologically, AEP was characterized by a perivascular lymphohistiocytic infiltrate with frequent eosinophils (74%) and epidermal changes in all but most of P-type biopsies. No definitive differential histopathological criteria between PEP and AEP were found. Only lymphocytic vasculitis with a mixed infiltrate with eosinophils was more frequent in PEP patients. Timing of onset, morphology of skin lesions, and a detailed clinicopathologic correlation are essential for diagnosis.
Collapse
|
9
|
Kieliszak CR, Pollinger TH, Tollefson MM, Griffin JR. Umbilical and periumbilical dermatoses. J Am Acad Dermatol 2015; 72:1066-73. [PMID: 25840731 DOI: 10.1016/j.jaad.2015.02.1100] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 02/05/2015] [Accepted: 02/11/2015] [Indexed: 11/26/2022]
Abstract
The umbilicus may be the site of congenital and acquired malformations and may harbor clinical clues to the diagnosis of potentially fatal inherited disorders, primary skin conditions, and a variety of infectious diseases. Both benign and malignant tumors may involve the umbilicus, and some are unique to this site. Finally, cutaneous signs localized to this anatomic location may be found in diverse systemic diseases.
Collapse
Affiliation(s)
- Christopher R Kieliszak
- Division of Otolaryngology, Head and Neck Surgery, George Washington University, Washington, DC
| | - Tess H Pollinger
- Department of Dermatology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Megha M Tollefson
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Department of Pediatrics, Mayo Clinic, Rochester, Minnesota
| | - John R Griffin
- Division of Dermatology, Baylor University Medical Center, Dallas, Texas; Department of Internal Medicine, Texas A&M University Health Science Center, Dallas, Texas; Department of Pathology and Laboratory Medicine, Texas A&M University Health Science Center, Dallas, Texas.
| |
Collapse
|
10
|
Abstract
Pregnancy is associated with complex of endocrinological, immunological, metabolic, and vascular changes that may influence the skin and other organs in various ways. Pregnancy is a period in which more than 90% women have significant and complex skin changes that may have great impact on the woman's life. The dermatoses of pregnancy represent a heterogeneous group of skin diseases related to pregnancy and/or the postpartum period. The dermatoses of pregnancy can be classified into the following three groups: Physiologic skin changes in pregnancy, pre-existing dermatoses affected by pregnancy, and specific dermatoses of 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. Correct diagnosis is essential for the treatment of these disorders. This article discusses the current knowledge of various skin changes during pregnancy and the evaluation of the patient with pregnancy dermatoses with special emphasis on clinical features, diagnostic tests, maternal and fetal prognosis, therapy, and management.
Collapse
Affiliation(s)
- Rita V Vora
- Department of Skin and VD, Pramukhswami Medical College and Shree Krishna Hospital, Gujarat, India
| | - Rajat Gupta
- Department of Skin and VD, Pramukhswami Medical College and Shree Krishna Hospital, Gujarat, India
| | - Malay J Mehta
- Department of Skin and VD, Pramukhswami Medical College and Shree Krishna Hospital, Gujarat, India
| | - Arvind H Chaudhari
- Department of Skin and VD, Pramukhswami Medical College and Shree Krishna Hospital, Gujarat, India
| | - Abhishek P Pilani
- Department of Skin and VD, Pramukhswami Medical College and Shree Krishna Hospital, Gujarat, India
| | - Nidhi Patel
- Department of Skin and VD, Pramukhswami Medical College and Shree Krishna Hospital, Gujarat, India
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Pemphigoid gestationis in a third trimester pregnancy. Case Rep Obstet Gynecol 2014; 2014:127628. [PMID: 25431712 PMCID: PMC4241730 DOI: 10.1155/2014/127628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 09/15/2014] [Accepted: 10/21/2014] [Indexed: 11/17/2022] Open
Abstract
Pemphigoid gestationis (PG) is a rare vesiculobullous dermatosis of pregnancy. It is commonly seen in second or third trimester. The diagnosis is frequently made with direct immunofluorescence studies of perilesional skin. Prompt recognition and appropriate management may reduce morbidity of this disease. Herein we present a case of pemphigoid gestationis occurring in a 33-year-old primigravida woman with symptoms of generalized pruritus.
Collapse
|
13
|
Bernstein JA, Lang DM, Khan DA, Craig T, Dreyfus D, Hsieh F, Sheikh J, Weldon D, Zuraw B, Bernstein DI, Blessing-Moore J, Cox L, Nicklas RA, Oppenheimer J, Portnoy JM, Randolph CR, Schuller DE, Spector SL, Tilles SA, Wallace D. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol 2014; 133:1270-7. [DOI: 10.1016/j.jaci.2014.02.036] [Citation(s) in RCA: 320] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 02/10/2014] [Accepted: 02/12/2014] [Indexed: 12/13/2022]
|
14
|
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.
Collapse
Affiliation(s)
- Stephanie Lehrhoff
- The Ronald O. Perelman Department of Dermatology, New York University, New York, New York 10016, USA.
| | | |
Collapse
|
15
|
Ghosh S, Chaudhuri S. Intra-hepatic Cholestasis of Pregnancy: A Comprehensive Review. Indian J Dermatol 2013; 58:327. [PMID: 23919027 PMCID: PMC3726904 DOI: 10.4103/0019-5154.113971] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Intra-hepatic cholestasis of pregnancy is a cholestatic disorder characterized by i) pruritus, with onset in the third trimester of pregnancy, without any primary skin lesions, ii) elevated fasting serum bile acids > 10 μmol/L (and elevated serum transaminases), iii) spontaneous relief of signs and symptoms within two to three weeks after delivery, and iv) absence of other disease that cause pruritus and jaundice. It is believed to be a multi-factorial disease with interplay between genetic, environmental and hormonal factors. Incidence is between 0.02% to 2.4% of all pregnancies; with wide geographical variations. Maternal prognosis is usually good but can result in adverse fetal outcomes like meconium staining of amniotic fluid, fetal bradycardia and even fetal loss. Response to anti-histaminic is poor. Of all the medical therapies that have been described for the treatment for IHCP, ursodeoxycholic acid has the best response in relieving pruritus in mother, and probably has a role in preventing even the perinatal complications. Timely diagnosis and treatment is urged in order to prevent fetal complications and an early delivery between 37 to 38 weeks should be contemplated in severe cases, especially once fetal lung maturity is attained.
Collapse
Affiliation(s)
- Sangita Ghosh
- Department of Skin and VD, PGIMS, Rohtak, Haryana, India
| | | |
Collapse
|
16
|
|
17
|
Chander R, Garg T, Kakkar S, Jain A. Specific Pregnancy Dermatoses in 1430 females from Northern India. J Dermatol Case Rep 2012; 5:69-73. [PMID: 22408706 DOI: 10.3315/jdcr.2011.1080] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Accepted: 06/14/2011] [Indexed: 12/27/2022]
Abstract
BACKGROUND The specific dermatoses of pregnancy represent a heterogenous group of ill-defined pruritic skin diseases, unique to pregnancy and post partum period. OBJECTIVE The aim of our study was epidemiological and clinical evaluation of various specific dermatoses of pregnancy. METHODS All patients visiting our antenatal clinic were screened for various pruritic skin conditions and those with specific pregnancy dermatoses were identified and evaluated. RESULTS Out of 1430 patients screened, nearly 5% (70 cases) patients had specific dermatoses of pregnancy. Intra hepatic cholestasis was the commonest specific pregnancy dermatoses. CONCLUSION Specific dermatoses of pregnancy can be diagnosed primarily on the basis of clinical features. All of these, except intra hepatic cholestasis, do not have any effect on normal course of pregnancy.
Collapse
Affiliation(s)
- Ram Chander
- Dept. of Dermatology & Venereology, Lady Hardinge Medical College, New Delhi, 11000, India
| | | | | | | |
Collapse
|
18
|
|
19
|
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.
Collapse
Affiliation(s)
- Sumit Kar
- Department of Dermatology, Venereology & Leprosy, Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sevagram, Wardha, Maharashtra 442012 India
| | | | | |
Collapse
|
20
|
Nejim T, Jenkins CS, Uncles DR, Coburn P. Emergency caesarean delivery of a parturient with undiagnosed pemphigoid gestationis. Int J Obstet Anesth 2012; 21:288-90. [PMID: 22626993 DOI: 10.1016/j.ijoa.2012.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 03/05/2012] [Accepted: 03/13/2012] [Indexed: 11/16/2022]
|
21
|
|
22
|
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.
Collapse
|
23
|
Abstract
The specific dermatoses of pregnancy represent a heterogeneous group of pruritic skin diseases that have been recently reclassified and include pemphigoid (herpes) gestationis, polymorphic eruption of pregnancy (syn. pruritic urticarial papules and plaques of pregnancy), intrahepatic cholestasis of pregnancy, and atopic eruption of pregnancy. They are associated with severe pruritus that should never be neglected in pregnancy but always lead to an exact work-up of the patient. Clinical characteristics, in particular timing of onset, morphology and localization of skin lesions are crucial for diagnosis which, in case of pemphigoid gestationis and intrahepatic cholestasis of pregnancy, will be confirmed by specific immunofluorescence and laboratory findings. While polymorphic and atopic eruptions of pregnancy are distressing only to the mother because of pruritus, pemphigoid gestationis may be associated with prematurity and small-for-date babies and intrahepatic cholestasis of pregnancy poses an increased risk for fetal distress, prematurity, and stillbirth. Corticosteroids and antihistamines control pemphigoid gestationis, polymorphic and atopic eruptions of pregnancy; intrahepatic cholestasis of pregnancy, in contrast, should be treated with ursodeoxycholic acid. This review will focus on the new classification of pregnancy dermatoses, discuss them in detail, and present a practical algorithm to facilitate the management of the pregnant patient with skin lesions.
Collapse
|
24
|
|
25
|
Abstract
The specific dermatoses of pregnancy represent a heterogeneous group of inflammatory skin diseases related to pregnancy and/or the postpartum period. The most recent classification includes pemphigoid gestationis, polymorphic eruption of pregnancy, intrahepatic cholestasis of pregnancy, and atopic eruption of pregnancy. The hallmark of all four entities is severe pruritus that is accompanied by characteristic skin changes. While some of these dermatoses are distressing only to the mother because of pruritus, others may be associated with significant fetal risks. Early diagnosis and prompt treatment are therefore essential. In this review, we will discuss the various pregnancy dermatoses in detail and present an algorithm for diagnosis and management of pruritus in pregnancy.
Collapse
Affiliation(s)
- C M Ambros-Rudolph
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Auenbruggerplatz 8, 8010, Graz, Österreich.
| |
Collapse
|
26
|
Lardenoije CMJG, van de Water M, Mertens HJMM, Gondrie ETCM. Pemphigoid gestationis. BMJ Case Rep 2011; 2011:bcr0120102623. [PMID: 22715180 PMCID: PMC3062810 DOI: 10.1136/bcr.01.2010.2623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 39-year-old woman in the 39th week of her fifth pregnancy presented with severe itching. In recent weeks she had developed an increasingly itchy rash on her trunk and arms. Upon examination we observed multiple erythematous plaques and vesicles. Histological examinations of two skin biopsies confirmed the diagnosis of pemphigoid gestationis. Because the patient's complaints worsened we decided to deliver the baby, and as it was in transverse lie this was by caesarean section. A healthy son without rash was born. Although pemphigoid gestationis occurs in only 1 in 50,000 pregnancies, it is very important to be aware of this condition when a pregnant woman has itching. Not recognising pemphigoid gestationis may lead to inadequate maternal treatment and possible preterm birth and neonatal pemphigoid gestationis.
Collapse
|
27
|
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.
Collapse
Affiliation(s)
- Maria-Magdalena Roth
- Department of Dermatology, "Elias" University Emergency Hospital, Bucharest, Romania.
| |
Collapse
|
28
|
Doiron P, Pratt M. Antepartum Intravenous Immunoglobulin Therapy in Refractory Pemphigoid Gestationis: Case Report and Literature Review. J Cutan Med Surg 2010; 14:189-92. [DOI: 10.2310/7750.2009.09001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Pemphigoid gestationis is an autoimmune blistering disease affecting pregnant women. Treatment often consists of topical corticosteroids, oral antihistamines, and oral prednisone followed by immunosuppressants. Refractory cases in antepartum patients present a particular therapeutic challenge as the majority of second-line agents are contraindicated until the patient has delivered. Objective: The following report describes the case of a 34-year-old woman pregnant for the third time at 16 weeks' gestation. Her previous two pregnancies were complicated by pemphigoid gestationis but were successfully managed with oral prednisone and topical agents. During her third pregnancy, the initial lesions were controlled with oral prednisone, but attempts to decrease her dose resulted in disease flare. Conclusion: Monthly infusions of intravenous immunoglobulin (40 g intravenously for 3 consecutive days for 120 g total) proved to be successful in reducing the dose of oral prednisone required to maintain disease remission. A healthy baby was delivered at 37.5 weeks.
Collapse
Affiliation(s)
- Philip Doiron
- From the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, and Division of Dermatology, University of Ottawa, Ottawa, ON
| | - Melanie Pratt
- From the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, and Division of Dermatology, University of Ottawa, Ottawa, ON
| |
Collapse
|
29
|
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.
Collapse
|
30
|
[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.
Collapse
|
31
|
Ambros-Rudolph CM, Vaughan Jones S, Black MM. Best serving the pregnant patient with pruritus. J Am Acad Dermatol 2008; 59:530-1. [DOI: 10.1016/j.jaad.2008.03.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Revised: 03/11/2008] [Accepted: 03/11/2008] [Indexed: 10/21/2022]
|
32
|
Ambros-Rudolph CM, Black MM. From prurigo gestationis Besnier to atopic eruption of pregnancy: the confusing nosology of the less well-defined dermatoses of pregnancy has been largely clarified. Clin Dermatol 2006; 24:545-7. [PMID: 17113973 DOI: 10.1016/j.clindermatol.2006.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
33
|
|
34
|
Abstract
Herpes gestationis, coined by Milton in 1872, or gestational pemphigoid is the most clearly characterized dermatosis of pregnancy. It is a rare vesiculo-bullous eruption that develops during the last trimester or even postpartum and creates severe pruritus. Its etiology is unknown, but it is considered as an autoimmune-mediated dermatosis closely related to the pemphigoid group. Herpes gestationis is associated with a positive C3 deposition along the base of the epidermis in salt-split skin, with increased frequency of HLA-DR3 and also the combination DR3 and DR4. It has a high risk of prematurity and disappears in the postpartum period within weeks or months.
Collapse
|
35
|
Ambros-Rudolph CM, Müllegger RR, Vaughan-Jones SA, Kerl H, Black MM. The specific dermatoses of pregnancy revisited and reclassified: Results of a retrospective two-center study on 505 pregnant patients. J Am Acad Dermatol 2006; 54:395-404. [PMID: 16488288 DOI: 10.1016/j.jaad.2005.12.012] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2005] [Revised: 11/13/2005] [Accepted: 12/04/2005] [Indexed: 11/21/2022]
Abstract
OBJECTIVES We sought to evaluate the frequency and clinical characteristics of pruritic dermatoses in pregnancy and to assess a rationalized classification. METHODS Data of 505 pregnant patients seen at two university-based dermatologic hospitals (1994-2004) were retrospectively studied. RESULTS Diagnoses included eczema in pregnancy (49.7%), polymorphic eruption of pregnancy (PEP) (21.6%), pemphigoid gestationis (PG) (4.2%), intrahepatic cholestasis of pregnancy (ICP) (3%), prurigo of pregnancy (0.8%), pruritic folliculitis of pregnancy (0.2%), and miscellaneous dermatoses (20.6%). Eczema in pregnancy, prurigo of pregnancy, and pruritic folliculitis of pregnancy showed considerable overlap and were summarized as atopic eruption of pregnancy (AEP). While PEP, PG, and ICP presented in late pregnancy, AEP started significantly earlier. Primigravidae and multiple gestations were characteristic for PEP, abdominal involvement for PEP and PG, and a history of affected pregnancies for ICP. LIMITATIONS This was a retrospective study. CONCLUSION We propose classifying the dermatoses of pregnancy as PG, PEP, AEP, and ICP. Stereotypic immunofluorescence and laboratory findings are diagnostic of PG and ICP, whereas distinct clinical characteristics facilitate discrimination between PEP and AEP.
Collapse
|
36
|
Abstract
Superficial inflammatory dermatoses are very common and comprise a wide, complex variety of clinical conditions. Accurate histological diagnosis, although it can sometimes be difficult to establish, is essential for clinical management. Knowledge of the microanatomy of the skin is important to recognise the variable histological patterns of inflammatory skin diseases. This article reviews the non-vesiculobullous/pustular inflammatory superficial dermatoses based on the compartmental microanatomy of the skin.
Collapse
Affiliation(s)
- K O Alsaad
- Department of Laboratory Medicine and Pathobiology, University of Toronto, University Health Network, Toronto, Ontario, Canada.
| | | |
Collapse
|
37
|
Abstract
Neste estudo conduz-se uma revisão bibliográfica da literatura sobre dermatologia e gravidez abrangendo o período de 1962 a 2003. O banco de dados do Medline foi consultado com referência ao mesmo período. Não se incluiu a colestase intra-hepática da gravidez por não ser ela uma dermatose primária; contudo deve ser feito o diagnóstico diferencial entre suas manifestações na pele e as dermatoses específicas da gravidez. Este apanhado engloba as características clínicas e o prognóstico das alterações fisiológicas da pele durante a gravidez, as dermatoses influenciadas pela gravidez e as dermatoses específicas da gravidez. Ao final apresenta-se uma discussão sobre drogas e gravidez.
Collapse
|
38
|
Kroumpouzos G, Cohen LM. Specific dermatoses of pregnancy: an evidence-based systematic review. Am J Obstet Gynecol 2003; 188:1083-92. [PMID: 12712115 DOI: 10.1067/mob.2003.129] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE We conducted an evidence-based systematic analysis of the literature on specific dermatoses of pregnancy. STUDY DESIGN The bibliographic databases MEDLINE and EMBASE were screened for studies and reports in all languages about herpes gestationis, pruritic urticarial papules and plaques of pregnancy, pruritic folliculitis of pregnancy, and prurigo of pregnancy from January 1962 to January 2002. As main index terms, including analogs and derivatives, we used the names of specific dermatoses of pregnancy. Intrahepatic cholestasis of pregnancy, not a primary dermatosis, was included herein because this disorder is associated with pregnancy and its secondary skin manifestations must be differentiated from specific dermatoses of pregnancy. Other sources were abstract books of symposia and congresses, theses, textbooks, monographs, reviews, editorials, letters to the editor, free or rapid communications, and the reference lists from all the articles that were retrieved. All articles selected for inclusion in this review were evaluated critically with regard to their impact factor and evidence-based contribution to this field, as measured by their citation index and impact factor of the journal in which they were published. Approximately 39% of articles met the selection criteria. RESULTS The clinical features and prognosis of the specific dermatoses of pregnancy have been delineated through a number of retrospective and cohort studies. The molecular biologic and immunogenetic properties of herpes gestationis, pruritic urticarial papules and plaques of pregnancy, and intrahepatic cholestasis of pregnancy have been further clarified. A meta-analysis in this review reveals a higher prevalence of multiple gestation pregnancy (11.7%) among patients with pruritic urticarial papules and plaques of pregnancy. Several investigations have unraveled the fetal complications in intrahepatic cholestasis of pregnancy and herpes gestationis. New treatment modalities in intrahepatic cholestasis of pregnancy (cholestyramine, ursodeoxycholic acid) and herpes gestationis (cyclosporin, intravenous immunoglobulin, and tetracyclines postpartum) have shown promise and warrant further evaluation. CONCLUSION During the past few decades, a significant amount of new data has provided new insights into the classification, pathogenesis, treatment, prognosis, and fetal risks that are associated with the specific dermatoses of pregnancy.
Collapse
Affiliation(s)
- George Kroumpouzos
- Division of Dermatology, Department of Medicine, Saint Vincent Hospital at Worcester Medical Center, Newton
| | | |
Collapse
|
39
|
Kolanko E, Bickle K, Keehn C, Glass LF. Subepidermal blistering disorders: a clinical and histopathologic review. ACTA ACUST UNITED AC 2003; 23:10-8. [PMID: 15095911 DOI: 10.1016/s1085-5629(03)00083-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The subepidermal blistering disorders are comprised of a number of unrelated disorders with a diverse clinical presentation and pathogenic basis that share in common the presence of blister formation beneath the epidermis. Many of the disorders are both debilitating and potentially fatal. Timely and accurate diagnosis facilitates their appropriate management. The etiologic, clinical, and pathologic attributes as well as the treatment of these disorders including bullous pemphigoid, epidermolysis bullosa acquisita, dermatitis herpetiformis, linear IgA dermatosis, cicatricial pemphigold, herpes gestationis,and porphyria cutanea tarda are described.
Collapse
Affiliation(s)
- Ewa Kolanko
- Divison of Dermatology, Department of Internal Medicine, University of South Florida College of Medicine, 12901 Bruce B. Downs Blvd, MDC 19, Tampa, FL 33612-4799, USA
| | | | | | | |
Collapse
|
40
|
|
41
|
Brazzini B, Ghersetich I, Urso C, Cianferoni L, Lotti T. Pityriasis lichenoides et varioliformis acuta during pregnancy. J Eur Acad Dermatol Venereol 2001; 15:458-60. [PMID: 11763391 DOI: 10.1046/j.1468-3083.2001.00341.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pityriasis lichenoides et varioliformis acuta (PLEVA) is a disorder of unknown aetiology that occurs at any age and can be localized on the skin and on the mucosas. We report the case of a 24-year-old woman who presented PLEVA at her 20th week of gestation. This is, to our knowledge, the second case of PLEVA during pregnancy reported in literature. We report this case for the importance of the diagnosis of PLEVA during pregnancy because of the possible involvement of the mucosal membranes, and in particular of the vagina or cervical os of the uterus, where it may cause premature labour and/or premature rapture of the membranes.
Collapse
Affiliation(s)
- B Brazzini
- Department of Dermoscience, University of Florence, Italy
| | | | | | | | | |
Collapse
|
42
|
Abstract
The dermatoses of pregnancy can be classified into the following 3 groups: physiologic skin changes in pregnancy, dermatoses and cutaneous tumors affected by pregnancy, and specific dermatoses of pregnancy. Correct diagnosis and classification are essential for the treatment of these disorders, when necessary. Laboratory investigations are required when the diagnosis remains in question despite a careful history and thorough physical examination. A discussion with the pregnant woman about the nature of her skin condition, and the possible fetal risks associated with it, is imperative.
Collapse
Affiliation(s)
- G Kroumpouzos
- Department of Dermatology, Boston Medical Center, Boston University School of Medicine, Massachusetts, USA
| | | |
Collapse
|
43
|
Abstract
This article reviews the literature that evaluates pruritic urticarial papules and plaques of pregnancy, herpes gestationis, and intrahepatic cholestasis of pregnancy and their impact on the fetus. Using MEDLINE years 1966 to 1999, a literature search was performed using the terms pregnancy, dermatology, pruritic urticarial papules and plaques of pregnancy, herpes gestationis, and intrahepatic cholestasis of pregnancy. References from the selected papers were then reviewed for additional sources. Thirty-seven studies were reviewed. Both original studies and review articles were included in the sources. The results of each study as originally reported are included to provide the reader the finding of each. The available literature reports no risk with pruritic urticarial papules and plaques of pregnancy; however, the current opinion of most was that there is an increased risk with herpes gestationis and intrahepatic papules and plaques of pregnancy. Although much information is known concerning these unique conditions, a consensus regarding their effect on the fetus has yet to be reached. Pregnancies affected by herpes gestationis and cholestasis of pregnancy should be considered high risk until more definitive evidence can be gained.
Collapse
Affiliation(s)
- G B Sherard
- Department of Obstetrics and Gynecology, East Carolina University--Brody School of Medicine, Greenville, North Carolina, USA.
| | | |
Collapse
|
44
|
|