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Xie F, Lehman JS, Baban F, Johnson EF, Theiler RN, Todd A, Davis DMR. Pemphigoid gestationis and polymorphic eruption of pregnancy: treatment and outcomes in a retrospective cohort study. Int J Dermatol 2024; 63:e29-e32. [PMID: 37916499 DOI: 10.1111/ijd.16884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 10/01/2023] [Accepted: 10/12/2023] [Indexed: 11/03/2023]
Affiliation(s)
- Fangyi Xie
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Julia S Lehman
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Farah Baban
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Division of Anatomic and Clinical Pathology, Mayo Clinic, Rochester, MN, USA
| | - Emma F Johnson
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Regan N Theiler
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Austin Todd
- Department of Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Dawn M R Davis
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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Munera-Campos M, Carrascosa JM. Atopic Dermatitis: Fertility, Pregnancy, and Treatment Perspectives. Am J Clin Dermatol 2024; 25:55-66. [PMID: 37904055 DOI: 10.1007/s40257-023-00821-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/01/2023]
Abstract
Hormonal and immunologic changes during pregnancy can contribute to the development of different dermatoses, the most common of which is atopic eruption of pregnancy (AEP). Of atopic dermatitis (AD) cases during pregnancy, 80% are new-onset presentations, while 20% represent recurrences or exacerbations of preexisting disease. Evidence on the effects of previous AD on fertility is limited. Different factors influence women's desire to conceive in this setting, and it has been hypothesized that barrier defects and systemic inflammation could contribute to biologic infertility, although more data are needed. Clinical practice suggests a tendency toward undertreatment in pregnant woman due to concerns about potential effects on obstetric and fetal outcomes. However, pregnant women should be offered adequate and safe treatments, preferably on an individual basis. The aim of this review was to summarize the evidence on disease course in pregnant women with AD and the challenges associated with its diagnosis and management. We also review the current evidence on the use of conventional and novel systemic therapies for AD in this population.
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Affiliation(s)
- Mónica Munera-Campos
- Department of Dermatology, Germans Trias i Pujol University Hospital, Autonomous University of Barcelona, Germans Trias i Pujol Research Institute (IGTP), Badalona, Barcelona, Spain.
| | - Jose Manuel Carrascosa
- Department of Dermatology, Germans Trias i Pujol University Hospital, Autonomous University of Barcelona, Germans Trias i Pujol Research Institute (IGTP), Badalona, Barcelona, Spain
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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.
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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.
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4
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Xie F, Davis DMR, Baban F, Johnson EF, Theiler RN, Todd A, Pruneddu S, Murase JE, Maul JT, Ambros-Rudolph CM, Lehman JS. Use of a pregnancy dermatology clinical scoring system to differentiate between pemphigoid gestationis and polymorphic eruption of pregnancy: practical considerations for the obstetrician. Am J Obstet Gynecol MFM 2023; 5:101078. [PMID: 37399893 DOI: 10.1016/j.ajogmf.2023.101078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/19/2023] [Indexed: 07/05/2023]
Affiliation(s)
- Fangyi Xie
- Department of Dermatology, Mayo Clinic, Rochester, MN; Department of Dermatology, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| | - Dawn Marie R Davis
- Departments of Dermatology and Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Farah Baban
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Emma F Johnson
- Departments of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Regan N Theiler
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | - Austin Todd
- Department of Biostatistics, Mayo Clinic, Rochester, MN
| | - Sara Pruneddu
- Department of Dermatology, King's College Hospital, London, United Kingdom
| | - Jenny E Murase
- Department of Dermatology, University of California San Francisco, San Francisco, CA
| | - Julia-Tatjana Maul
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | | | - Julia S Lehman
- Departments of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905.
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Xie F, Davis DMR, Baban F, Johnson EF, Theiler RN, Todd A, Pruneddu S, Murase JE, Maul JT, Ambros-Rudolph CM, Lehman JS. Development and multicenter international validation of a diagnostic tool to differentiate between pemphigoid gestationis and polymorphic eruption of pregnancy. J Am Acad Dermatol 2023; 89:106-113. [PMID: 36739091 DOI: 10.1016/j.jaad.2023.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/03/2023] [Accepted: 01/20/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Pemphigoid gestationis (PG) and polymorphic eruption of pregnancy (PEP) may be similar morphologically but confer different maternal and fetal risks. Direct immunofluorescence is the gold standard test used to differentiate between the 2 diagnoses but is not always available. OBJECTIVE To develop and validate a clinical scoring system to differentiate PG from PEP. METHODS After developing a scoring system based on differentiating clinical factors reported in existing literature, we tested its diagnostic accuracy in a retrospective international multicenter validation study in collaboration with the European Academy of Dermatology and Venereology's Skin Diseases in Pregnancy Taskforce. RESULTS Nineteen pregnancies (16 patients) affected by PG and 39 pregnancies (39 patients) affected by PEP met inclusion criteria. PG had a mean score of 4.6 (SD, 2.5) and PEP had a mean score of -0.3 (SD, 2.0). The area under the curve was 0.93 (95% CI, 0.86-1.00). Univariate analysis revealed that almost all criteria used in the scoring system were significantly different between the groups (P < .05), except for skip pregnancy and multiple gestations, which were then removed from the final scoring system. LIMITATIONS Small retrospective study. CONCLUSION The Pregnancy Dermatoses Clinical Scoring System may be useful to differentiate PG from PEP in resource-limited settings.
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Affiliation(s)
- Fangyi Xie
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Department of Dermatology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Dawn Marie R Davis
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Farah Baban
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Emma F Johnson
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Regan N Theiler
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - Austin Todd
- Department of Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - Sara Pruneddu
- Department of Dermatology, King's College Hospital, London, UK
| | - Jenny E Murase
- Department of Dermatology, University of California San Francisco, California
| | - Julia-Tatjana Maul
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | | | - Julia S Lehman
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
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De Caux D, Mariappa G, Perera G, Girling J. Prescribing for pregnancy: chronic skin diseases. Drug Ther Bull 2023; 61:55-60. [PMID: 36990470 DOI: 10.1136/dtb.2022.000036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Chronic skin disease is common in women of reproductive age. Although skin can improve or remain stable during pregnancy, it is also common for existing conditions to flare and for new conditions to develop. A small number of medications used to control chronic skin disease can potentially have adverse effects on the outcome of the pregnancy. This article forms part of a series on prescribing for pregnancy and highlights the importance of achieving good control of the skin disease prior to conception and during pregnancy. It emphasises the need for patient-centred, open and informed discussions around medication options to achieve good control. During pregnancy and breastfeeding each patient should be treated as an individual in accordance with the medications that are appropriate for them, their preferences, and the severity of their skin disease. This should be done through collaborative working across primary care, dermatology and obstetric services.
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Affiliation(s)
- Deborah De Caux
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Gayathri Perera
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Joanna Girling
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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Recognizing, Diagnosing, and Managing Pregnancy Dermatoses. Obstet Gynecol 2022; 140:679-695. [PMID: 36075066 DOI: 10.1097/aog.0000000000004938] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/26/2022] [Indexed: 01/05/2023]
Abstract
Pregnancy dermatoses are inflammatory skin disorders that occur during pregnancy or immediately postpartum. This heterogenous group of disorders includes pemphigoid gestationis, polymorphic eruption of pregnancy, intrahepatic cholestasis of pregnancy, atopic eruption of pregnancy, and pustular psoriasis of pregnancy. In this article, we provide a comprehensive literature review of each condition focusing on nomenclature, epidemiology, pathogenesis, clinical presentation, diagnosis, differential diagnosis, maternal risk, fetal risk, and treatment. We aim to increase awareness and help clinicians recognize, diagnose, and manage these unique conditions.
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Diagnostic Pitfall in Atypical Febrile Presentation in a Patient with a Pregnancy-Specific Dermatosis—Case Report and Literature Review. Medicina (B Aires) 2022; 58:medicina58070847. [PMID: 35888566 PMCID: PMC9315689 DOI: 10.3390/medicina58070847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 12/04/2022] Open
Abstract
Pruritic urticarial papules and plaques of pregnancy (PUPPP) usually occurs in the third trimester of pregnancy in primiparous women. It is a self-limiting inflammatory disorder with a still unknown pathogenic mechanism. The abdominal wall overdistension, with a subsequent inflammatory response due to damage to the connective tissue, represents a pathogenesis explanation. Clinical features involve intensely pruritic urticarial rash with edematous, erythematous papules and plaques. The clinical picture and dermal biopsy establish the diagnosis. Topical corticosteroids and oral antihistamines are usually sufficient, but sometimes systemic corticosteroids are necessary. Maternal and fetal prognosis is excellent, and the lesions resolve after birth with no scarring or pigmentary change. We present a case of a 36-year-old patient with a 32-week pregnancy who was admitted with a generalized pruritic rash accompanied by fever. The final diagnosis was decided after multiple pathology exclusions. Treatment consisted of systemic corticoid therapy. The patient gave birth by cesarean section to a healthy newborn without dermatological lesions or other conditions. Adding more PUPPP cases to the literature portfolio will bring more awareness to this under-recognized and under-reported skin disorder. We trust this case will encourage other physicians to publish more cases of pregnancy-specific dermatoses.
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Pemphigoid Gestationis and adverse pregnancy outcomes: A Literature review. J Gynecol Obstet Hum Reprod 2022; 51:102370. [DOI: 10.1016/j.jogoh.2022.102370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/24/2022] [Accepted: 03/31/2022] [Indexed: 11/23/2022]
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Abstract
Pruritus in pregnancy is a common and burdensome symptom that may be a first sign of a pregnancy-specific pruritic disease (atopic eruption of pregnancy, polymorphic eruption of pregnancy, pemphigoid gestationis, and intrahepatic cholestasis in pregnancy) or a dermatosis coinciding with pregnancy by chance. Despite its high prevalence, pruritus is often underrated by physicians, and data regarding the safety profiles of drugs for pruritus are very limited. In this review, we illustrate the epidemiology, possible pathophysiology, clinical characteristics, and diagnostic workup of various pregnancy-related diseases and discuss antipruritic treatments. The prevalence of pruritus in pregnancy demonstrates the importance of symptom recognition and the need for an holistic approach, taking into account both the potential benefits for the patient and the potential risks to the fetus.
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Affiliation(s)
- Aleksandra A Stefaniak
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Von Esmarch Str 58, 48149, Münster, Germany.
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wrocław, Poland.
| | - Manuel P Pereira
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Von Esmarch Str 58, 48149, Münster, Germany
| | - Claudia Zeidler
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Von Esmarch Str 58, 48149, Münster, Germany
| | - Sonja Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Von Esmarch Str 58, 48149, Münster, Germany
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Balakirski G, Novak N. Atopic Dermatitis and Pregnancy. J Allergy Clin Immunol 2022; 149:1185-1194. [DOI: 10.1016/j.jaci.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 12/28/2021] [Accepted: 01/07/2022] [Indexed: 11/26/2022]
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Rudder M, Lefkowitz EG, Ruhama T, Firoz E. A review of pruritus in pregnancy. Obstet Med 2021; 14:204-210. [PMID: 34880932 PMCID: PMC8646210 DOI: 10.1177/1753495x20985366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 11/16/2022] Open
Abstract
Pruritus is a common dermatologic complaint during pregnancy. Pruritus is reported by 23-38% of women during pregnancy, and 2% report severe pruritus. In addition to interfering with sleep and reducing overall quality of life during pregnancy, pruritus may be the first, or only, symptom of an underlying disorder that may impact maternal and fetal outcomes. It is therefore critical for all providers caring for pregnant women to be familiar with pregnancy-specific and non-specific conditions associated with pruritus to most effectively manage this unique population. In this review, we discuss clinical classification of pruritus, a practical approach to the differential diagnosis of pruritus in pregnancy, and focus on updates in the clinical features, diagnosis, management, and prognosis of pregnancy-specific causes of pruritus.
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Affiliation(s)
- Meghan Rudder
- Department of Medicine, Women & Infants’ Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Emily G Lefkowitz
- Department of Dermatology, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Tereda Ruhama
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Elnaz Firoz
- Department of Dermatology, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA
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Amorim MRCDF, Cavaliere FAM, Brito EOXD, Mota ANCDM. Case for diagnosis. Pregnant woman in the 3 rd trimester with pruritic papules and pustules on the trunk. Pruritic folliculitis of pregnancy. An Bras Dermatol 2021; 97:102-104. [PMID: 34794830 PMCID: PMC8799852 DOI: 10.1016/j.abd.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/24/2021] [Accepted: 07/26/2021] [Indexed: 12/01/2022] Open
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Papp KA, Hong CH, Lansang MP, Turchin I, Adam DN, Beecker JR, Bissonnette R, Gooderham MJ, Jack C, Joseph M, Lynde CW, Shear NH. Practical Management of Patients with Atopic Dermatitis on Dupilumab. Dermatol Ther (Heidelb) 2021; 11:1805-1828. [PMID: 34510403 PMCID: PMC8435113 DOI: 10.1007/s13555-021-00586-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/25/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Dupilumab is approved to treat moderate-to-severe atopic dermatitis (AD) in several countries in patients as young as 6 years of age. Since its approval, practical issues related to the use of dupilumab for AD have arisen, with particular interest in transitioning from current therapies and managing medication overlap, considerations for special populations of patients with AD, and management of potential adverse events. METHODS This article aims to review the literature addressing several practical management issues related to dupilumab use for AD and to provide a framework for clinical decision-making in these circumstances and sub-populations. Each statement was reviewed, revised and voted on by authors to provide their level of agreement and degree of uncertainty for each statement. RESULTS An agreement level > 80% was achieved for all of the statements. CONCLUSION The expert panel provides statements considering the practical management of patients with AD taking dupilumab to inform clinical decision-making in specific but frequently encountered clinical situations.
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Affiliation(s)
- Kim A Papp
- Probity Medical Research, Waterloo, ON, Canada.
- K. Papp Clinical Research, 135 Union St E, Waterloo, ON, N2J 1C4, Canada.
| | - Chih-Ho Hong
- Probity Medical Research, Waterloo, ON, Canada
- Dr. Chih-ho Hong Medical, Inc, Surrey, BC, Canada
| | - M Perla Lansang
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Irina Turchin
- Probity Medical Research, Waterloo, ON, Canada
- Brunswick Dermatology Centre, Fredericton, NB, Canada
| | - David N Adam
- Probity Medical Research, Waterloo, ON, Canada
- Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- CCA Medical Research, Ajax, ON, Canada
| | - Jennifer R Beecker
- Probity Medical Research, Waterloo, ON, Canada
- Division of Dermatology, The Ottawa Hospital, Ottawa, ON, Canada
- Division of Dermatology, University of Ottawa, Ottawa, ON, Canada
| | | | - Melinda J Gooderham
- Probity Medical Research, Waterloo, ON, Canada
- SKiN Centre for Dermatology, Peterborough, ON, Canada
| | - Carolyn Jack
- Division of Dermatology, McGill University, Montreal, QC, Canada
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Marissa Joseph
- Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Dermatology, Women's College Hospital, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Charles W Lynde
- Probity Medical Research, Waterloo, ON, Canada
- Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Lynderm Research, Markham, ON, Canada
| | - Neil H Shear
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Ceryn J, Siekierko A, Skibińska M, Doss N, Narbutt J, Lesiak A. Pemphigoid Gestationis - Case Report and Review of Literature. Clin Cosmet Investig Dermatol 2021; 14:665-670. [PMID: 34168478 PMCID: PMC8218239 DOI: 10.2147/ccid.s297520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/18/2021] [Indexed: 12/14/2022]
Abstract
Pemphigoid gestationis (PG) is a rare autoimmune bullous skin disorder which usually presents with intense pruritus and urticarial lesions that may evolve into vesicles and tense blisters. In majority of patients, it starts in the second or third trimester of pregnancy and resolves spontaneously after delivery. Lesions appear in the periumbilical area in 90% of patients and rapidly spread centrifugally to other parts of the body. The diagnosis needs to be confirmed by direct immunofluorescence test (DIF) with indirect immunofluorescence test (IIF), ELISA and immunoblot techniques playing role in diagnosis and/or monitoring antibodies level. Mild symptoms of PG can be treated with topical therapy only, but in severe course of the disease the treatment may be escalated to oral corticosteroids. We present an unusual case of PG started 2 weeks after delivery with an updated overview on the epidemiology, pathology, clinical picture, treatment, and complications of the disease.
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Affiliation(s)
- Justyna Ceryn
- Department of Dermatology, Pediatric Dermatology and Oncology Clinic, Medical University of Lodz, Lodz, Poland
| | - Aleksandra Siekierko
- Department of Dermatology, Pediatric Dermatology and Oncology Clinic, Medical University of Lodz, Lodz, Poland
| | - Małgorzata Skibińska
- Department of Dermatology, Pediatric Dermatology and Oncology Clinic, Medical University of Lodz, Lodz, Poland
| | - Nejib Doss
- Golden Towers Medical Center, Centre Urbain Nord, Tunis, 1082, Tunisia
| | - Joanna Narbutt
- Department of Dermatology, Pediatric Dermatology and Oncology Clinic, Medical University of Lodz, Lodz, Poland
| | - Aleksandra Lesiak
- Department of Dermatology, Pediatric Dermatology and Oncology Clinic, Medical University of Lodz, Lodz, Poland
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16
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Subepithelial autoimmune blistering dermatoses: Clinical features and diagnosis. J Am Acad Dermatol 2021; 85:1-14. [PMID: 33684496 DOI: 10.1016/j.jaad.2020.11.076] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 11/01/2020] [Accepted: 11/02/2020] [Indexed: 01/19/2023]
Abstract
Subepithelial autoimmune blistering dermatoses are a group of rare skin disorders that are characterized by the disruption of the dermal-epidermal junction through the action of autoantibodies. The third article in this continuing medical education series explores the background, epidemiology, clinical features, and diagnostic criteria of each of the major subepithelial autoimmune blistering dermatoses, including bullous pemphigoid, pemphigoid gestationis, lichen planus pemphigoides, mucous membrane pemphigoid, linear IgA bullous dermatosis, and dermatitis herpetiformis.
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17
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Dokuzeylul Gungor N, Gurbuz T, Ture T. Prolonged luteal phase support with progesterone may increase papules and plaques of pregnancy frequency in pregnancies through in vitro fertilization. An Bras Dermatol 2021; 96:171-175. [PMID: 33573870 PMCID: PMC8007486 DOI: 10.1016/j.abd.2020.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/08/2020] [Accepted: 09/22/2020] [Indexed: 11/30/2022] Open
Abstract
Background Pruritic urticarial papules and plaques of pregnancy development may have a strong relationship with hormone treatments during in vitro fertilization and hormonal changes during pregnancy. Objectives The aim of this study was to evaluate and compare the frequency of papules and plaques of pregnancy and related factors in in vitro fertilization pregnancies and spontaneous pregnancies. Methods In this study, 517 in vitro fertilization pregnancies and 1253 spontaneous pregnancies were retrospectively reviewed for papules and plaques of pregnancy frequency. The diagnosis of papules and plaques of pregnancy was performed by referral to the dermatology department and according to the typical clinical manifestations of the disease. Results The papules and plaques of pregnancy was more common in all in vitro fertilization pregnancies (including single pregnancies) than in spontaneous pregnancies. Age, Rh positivity, mother weight gain, onset of disease during gestation, duration of disease, birth weight and the frequency of male fetus were similar between the two groups (p > 0.05). The rate of multiple pregnancies was higher in in vitro fertilization pregnancies with papules and plaques of pregnancy than in vitro fertilization pregnancies without papules and plaques of pregnancy (p < 0.001). Duration of progesterone treatment was also significantly longer in in vitro fertilization pregnancies with papules and plaques of pregnancy compared to in vitro fertilization pregnancies without papules and plaques of pregnancy (p < 0.001). Study limitations The limitations of the study were the retrospective and single-centered design. Conclusion The results of this study indicate that increased progesterone dosage or prolonged treatment may play a role in the pathogenesis papules and plaques of pregnancy.
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Affiliation(s)
- Nur Dokuzeylul Gungor
- Department of Reproductive Medicine and IVF, Goztepe Medical Park Hospital, Istanbul, Turkey.
| | - Tugba Gurbuz
- Department of Obstetrics and Gynecology, Nisantasi University and Private Medistate Hospital, Istanbul, Turkey
| | - Tugba Ture
- Department of Dermatology, Private Clinic, Istanbul, Turkey
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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.
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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.
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19
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Savervall C, Thomsen SF. Managing Pemphigoid Gestationis. EUROPEAN MEDICAL JOURNAL 2020. [DOI: 10.33590/emj/19-00209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Pemphigoid gestationis (PG) is important to diagnose and treat because it carries considerable morbidity for the pregnant woman and can also constitute a risk to the fetus. Herein, the treatment options for PG and a proposed treatment algorithm for PG during pregnancy, breastfeeding, and late postpartum are reviewed.
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20
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Correlation of nipple eczema in pregnancy with atopic dermatitis in Northern India: a study of 100 cases. An Bras Dermatol 2019; 94:549-552. [PMID: 31777355 PMCID: PMC6857550 DOI: 10.1016/j.abd.2018.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 10/18/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Nipple eczema is a less common presentation of atopic dermatitis. No studies in the literature have correlated nipple eczema in pregnancy as a manifestation of atopic dermatitis. OBJECTIVE To evaluate whether nipple eczema presenting in pregnancy is a manifestation of atopic dermatitis. METHODS This was a prospective observational study including 100 women who presented with nipple eczema for the first time during pregnancy. The exclusion criteria were any patient with previous history of nipple eczema, those already on oral or topical treatment for atopic dermatitis or nipple eczema, and other disorders mimicking eczema. Patients were divided into two groups ‒ nipple eczema with atopic dermatitis and without atopic dermatitis. Demographic data, clinical features, total leukocyte count, differential leukocyte count, absolute eosinophil counts, and serum IgE levels were compared between the two groups to detect association between nipple eczema in pregnancy and atopic dermatitis. RESULTS Out of 100 patients, 39 were diagnosed with atopic dermatitis, whereas 61 were ruled out to have any features suggestive of atopic dermatitis. There were no statistically significant differences in mean age, mean duration of symptoms, and serum IgE levels. In patients with atopic dermatitis, bilateral symptoms were noted more commonly than in patients without the disease, but this was statistically insignificant. STUDY LIMITATIONS Lack of long term follow-up and no large studies in literature to compare results. CONCLUSION Nipple eczema in pregnancy follows a similar pattern as in other age groups. The clinical profile of patients is similar in cases with and without atopic dermatitis.
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21
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Maglie R, Quintarelli L, Verdelli A, Fabbri P, Antiga E, Caproni M. Specific dermatoses of pregnancy other than pemphigoid gestationis. GIORN ITAL DERMAT V 2018; 154:286-298. [PMID: 30375214 DOI: 10.23736/s0392-0488.18.06159-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Specific dermatoses of pregnancy are skin disorders that occur specifically during or immediately after pregnancy and cannot be found in non-pregnant patients. According to the current consensus, they include atopic eruption of pregnancy (AEP), polymorphic eruption of pregnancy (PEP), pemphigoid gestationis (PG), and intrahepatic cholestasis of pregnancy (ICP). The diagnosis of specific dermatoses of pregnancy can be challenging due to their variation in clinical presentation; moreover, the tests currently available do not always provide the clue for the diagnosis. However, some distinctive features may be helpful to differentiate between such entities. Accordingly, the knowledge of specific dermatoses of pregnancy and of their management is critical, since their early recognition may allow to provide care for the mother and prevent potential increased fetal risk. In fact, while AEP and PEP do not affect maternal and fetal prognosis, PG and, mainly, ICP are associated to maternal complications as well as the risk of fetal loss. In this paper, the epidemiology, pathogenesis, clinical features as well as management of AEP and PEP are reviewed in detail, while PG is described in another article of this issue. Moreover, the main features of ICP, which cannot be considered a primarily skin disease but may be managed first by dermatologists, are reported.
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Affiliation(s)
- Roberto Maglie
- Section of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Lavinia Quintarelli
- Section of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Alice Verdelli
- Section of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Paolo Fabbri
- Section of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Emiliano Antiga
- Section of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy -
| | - Marzia Caproni
- Section of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
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22
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Hamann CR, Egeberg A, Wollenberg A, Gislason G, Skov L, Thyssen JP. Pregnancy complications, treatment characteristics and birth outcomes in women with atopic dermatitis in Denmark. J Eur Acad Dermatol Venereol 2018; 33:577-587. [PMID: 30242910 DOI: 10.1111/jdv.15256] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 08/20/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND The risk of prenatal, obstetric and birth complications in mothers with atopic dermatitis (AD), along with treatment use during pregnancy, is unknown. OBJECTIVES To examine the associations between prenatal, obstetric and birth complications in mothers with AD and describe the dermatologic care received during pregnancy. METHODS Mother-child pairs, in which the mother had a history of AD, were identified through the Danish Medical Birth Registry and matched 1 : 10 with non-AD pairs. Data on dermatologic treatment and prenatal, obstetric and birth complications were obtained through linkage via nationwide registers. Multiple logistic regression was performed. RESULTS We identified 10 668 births from 1997 through 2014 to women with AD. Women with a hospital/ambulatory contact for AD during pregnancy had increased topical corticosteroid and ultraviolet therapy use during pregnancy compared to prior. However, overall, women with AD received decreased dermatologic therapy during pregnancy compared to prior. In adjusted analysis, maternal AD was inversely associated with gestational diabetes [OR 0.79, 95% CI (0.68-0.92)], but positively associated with premature rupture of membranes [1.15 (1.05-1.27)] and staphylococcal neonatal septicemia [2.45 (1.33-4.49)]-albeit the latter was rare. These associations did not meet statistical significance in sub-analysis where body mass index data were available. No associations were found with preeclampsia, prematurity or non-staphylococcal neonatal septicaemia. CONCLUSIONS Women with AD during pregnancy mainly used topical corticosteroids and ultraviolet therapy to control their disease. While premature rupture of membranes and staphylococcal neonatal septicaemia were over-represented in maternal AD, no associations were found with any other significant prenatal, obstetric or birth outcome.
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Affiliation(s)
- C R Hamann
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Copenhagen Research Group for Inflammatory Skin (CORGIS), Hellerup, Denmark.,School of Health and Medical Science, Graduate Programme in Public Health and Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - A Egeberg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Copenhagen Research Group for Inflammatory Skin (CORGIS), Hellerup, Denmark
| | - A Wollenberg
- Department of Dermatology and Allergy, Ludwig-Maximilian-University, Munich, Germany
| | - G Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - L Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Copenhagen Research Group for Inflammatory Skin (CORGIS), Hellerup, Denmark
| | - J P Thyssen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Copenhagen Research Group for Inflammatory Skin (CORGIS), Hellerup, Denmark
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23
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Abstract
Pruritus in pregnancy can be a source of significant discomfort in the pregnant patient. Some cases are associated with pregnancy-specific dermatoses, although some patients experience a flare of a preexisting dermatosis. Severe pruritus may be a manifestation of a pregnancy-specific dermatosis associated with increased fetal risks and complications. Early accurate diagnosis and appropriate management are important. Examination often reveals important clinical findings, aiding accurate diagnosis. Pemphigoid gestationis often presents with periumbilical involvement, whereas polymorphic eruption of pregnancy spares the umbilicus and presents in the striae distensae. Intrahepatic cholestasis of pregnancy is associated with intense pruritus of the palms.
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Affiliation(s)
- Mark A Bechtel
- Division of Dermatology, Ohio State University College of Medicine, 540 Officenter Place, #240, Gahanna, OH 43230, USA.
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24
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Abstract
Many skin diseases can occur in pregnant women. However, a few pruritic dermatological conditions are unique to pregnancy, including pemphigoid gestationis (PG). As PG is associated with severe morbidity for pregnant women and carries fetal risks, it is important for the clinician to quickly recognize this disease and refer it for dermatological evaluation and treatment. Herein, we review the pathogenesis, clinical characteristics, and management of PG.
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Affiliation(s)
| | - Freja Lærke Sand
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Simon Francis Thomsen
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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25
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Panicker VV, Riyaz N, Balachandran PK. A clinical study of cutaneous changes in pregnancy. J Epidemiol Glob Health 2016; 7:63-70. [PMID: 27870929 PMCID: PMC7320517 DOI: 10.1016/j.jegh.2016.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 07/06/2016] [Accepted: 10/19/2016] [Indexed: 11/25/2022] Open
Abstract
Background/objective: Pregnant women experience a myriad of physiological and metabolic changes that affect different organ systems in the body. Cutaneous and appendageal alterations that manifest during pregnancy are largely modulated by hormonal, immunologic, and metabolic factors. Detailed reports encompassing physiological changes and specific dermatoses of pregnancy and effects of various dermatoses on pregnant women are scanty in literature. This study was conducted to examine in detail both physiological changes and specific dermatoses. The cutaneous changes are divided into physiological changes, skin diseases aggravated by pregnancy, and specific dermatoses of pregnancy. The objectives were to study the various cutaneous changes of pregnancy and to know the proportion of these cutaneous manifestations in pregnant women. Methods: This study included 600 pregnant women attending the Obstetrics and Gynecology Department of a tertiary teaching hospital in Northern Kerala, India. Detailed history elicitation and complete physical and dermatological examination were performed. Skin biopsy was performed in relevant cases. Results: Cutaneous changes were seen in a majority of patients, of which physiological changes were the most common (99%). The most common cutaneous manifestation was hyperpigmentation (526; 87.6%), followed by striae gravidarum (72.8%). Other changes were vascular, including pedal edema (10%), pregnancy gingivitis (1.8%), and varicose veins (1%). Infections were the common dermatological problem in this study group. The most common infections were vulvovaginal candidiasis (21%), Tinea versicolor (6%), scabies (2.8%), dermatophytosis (1.5%), and sexually transmitted infection (0.5%). Specific dermatoses were seen in 12 cases (2%), with the most common being pruritic urticarial papules and plaques of pregnancy (1.3%). Conclusion: Pregnant women are prone to suffer from a wide range of dermatological problems apart from specific dermatoses of pregnancy. The study emphasizes the need for a detailed and meticulous examination of these patients to detect these various disorders.
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Affiliation(s)
- Vinitha V Panicker
- Department of Dermatology, Amrita Institute of Medical Sciences and Research Centre, Edappally, Ernakulam, Kerala, India.
| | - Najeeba Riyaz
- Department of Dermatology, Government Medical College, Calicut, Kerala, India
| | - P K Balachandran
- Department of Dermatology, Government Medical College, Alappuzha, Kerala, India
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26
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Abstract
Pemphigus is a group of immune-mediated bullous disorders, which often cause fragile blisters and extensive lesions of the skin or mucous membranes, such as in the mouth. This disease could be life-threatening in some cases. During pregnancy, its condition will become more complicated due to the change in the mother’s hormone level and the effect of drug therapy on both the mother and her fetus. Thus, it will be more difficult to identify the clinical manifestations and to establish the treatment plan. In this article, we present a comprehensive review of pemphigus and pregnancy by analyzing 47 cases of pemphigus reported between 1966 and 2014, with diagnosis before or during pregnancy. The aim of this study is to make a comprehensive review of pemphigus and pregnancy, provide organized and reliable information for obstetricians, dermatologists, physicians, and oral medicine specialists.
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Affiliation(s)
- Lin Lin
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China. E-mail.
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27
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Monakhov KN, Kholodilova NA. The experiment of using loratadinum in pregnant women with pruritic dermatoses. VESTNIK DERMATOLOGII I VENEROLOGII 2016. [DOI: 10.25208/0042-4609-2016-92-3-123-127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Results of examination of 64 pregnant women with allergic dermatosis. Provides results of the efficacy, tolerance and safety study of the loratadinum drug in pregnant women with allergic dermatosis.
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28
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Retrospective analysis of pemphigoid gestationis in 32 Saudi patients - Clinicopathological features and a literature review. J Reprod Immunol 2016; 116:42-5. [PMID: 27175516 DOI: 10.1016/j.jri.2016.04.286] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 03/23/2016] [Accepted: 04/20/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Pemphigoid gestationis (PG) is a rare autoimmune-mediated blistering disease that mainly affects pregnant women in their 2nd or 3rd trimester and immediate postpartum period. In addition to the clinical assessment, the diagnosis of PG is usually confirmed by histological and immunological studies. PG usually flares up at the time of delivery and spontaneously improves postpartum. Prompt recognition and appropriate management may reduce morbidity associated with this disorder. This study aimed to determine the clinical, histopathological features and treatment of PG of Saudi patients. MATERIALS AND METHODS A retrospective study of 32 patients with pemphigoid gestationis (PG) was conducted from 1990 to 2014 at King Khalid University Hospital and Derma Medical Center, Riyadh, Saudi Arabia. Data regarding epidemiology, medical histories, clinical course, diagnostic test results and management were collected and analyzed. RESULTS A total of 32 patients with PG were analyzed. The mean age was 31.9 years. Seventy-four percent of the patients were multigravidas, and 2 patients were primigravidas. One hundred percent of the cases were singleton pregnancies. Eighty-four percent of the cases had the onset of PG during the 2nd and 3rd trimesters. One hundred percent of patients complained of pruritus, and 94% reported this as the first symptom. Erythematous plaques and vesiculobullous eruption were the most common skin presentation. The primary sites of involvement were the abdomen, trunk, lower (mainly thighs) and upper limbs. The face and mucus membranes were rarely involved. Fifty percent of patients had recurrent symptoms with their next pregnancy. Direct immunofluorescence revealed a linear deposition of the third component of the complement along the basement membrane zone in all cases (C3),while most of the cases showed positive linear deposition of IgG. Seventy five percent of our patients had a good response to oral corticosteroids, and only one patient needed IVIG. The vast majority of the patients (61%) became free of symptoms within 1-2 months of treatment. In 53% of the patients, maternal and fetal outcomes were good with no complications. Six pregnancies were complicated by preterm labor, 2 experienced IUGR (intrauterine growth restriction), and 2 had an abortion or stillbirth. CONCLUSION Our study does not differ dramatically when comparing the onset of PG, the high frequency of multigravida women, the clinical course and good patient outcomes but we observed that the first attack extended from primigravida to 11th pregnancy and slight increase in recurrence rate. Finally the timely diagnosis and appropriate management of PG may improve both maternal and neonatal outcome.
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29
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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]
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30
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Yang CS, Teeple M, Muglia J, Robinson-Bostom L. Inflammatory and glandular skin disease in pregnancy. Clin Dermatol 2016; 34:335-43. [DOI: 10.1016/j.clindermatol.2016.02.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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32
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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.
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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.
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33
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Dermatological Diseases Associated with Pregnancy: Pemphigoid Gestationis, Polymorphic Eruption of Pregnancy, Intrahepatic Cholestasis of Pregnancy, and Atopic Eruption of Pregnancy. Dermatol Res Pract 2015; 2015:979635. [PMID: 26609305 PMCID: PMC4644842 DOI: 10.1155/2015/979635] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 10/11/2015] [Indexed: 12/16/2022] Open
Abstract
Dermatoses unique to pregnancy are important to recognize for the clinician as they carry considerable morbidity for pregnant mothers and in some instances constitute a risk to the fetus. These diseases include pemphigoid gestationis, polymorphic eruption of pregnancy, intrahepatic cholestasis of pregnancy, and atopic eruption of pregnancy. This review discusses the pathogenesis, clinical importance, and management of the dermatoses of pregnancy.
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Abstract
The dermatoses of pregnancy represent a distinct heterogenous group of cutaneous disorders that can impact the health of the pregnant woman and potentially the fetus. The current classification of pregnancy-specific cutaneous disorders is reviewed, along with important clinical features. Advances in management of these disorders, along with fetal implications, are discussed. The diagnosis of these disorders is challenging, but important clinical features can aid in diagnosis. There have been important advances in the management of these disorders and better understanding of potential fetal risks. Early recognition is critical for appropriate care.
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35
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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.
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36
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Soutou B, Aractingi S. Skin disease in pregnancy. Best Pract Res Clin Obstet Gynaecol 2015; 29:732-40. [PMID: 25862358 DOI: 10.1016/j.bpobgyn.2015.03.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 02/26/2015] [Accepted: 03/06/2015] [Indexed: 11/19/2022]
Abstract
Skin manifestations during pregnancy are common and diversified. This review will focus on the most important entities to be recognized by obstetricians. These are, on the one hand, physiological changes, where unnecessary investigations should be avoided, and on the other, the specific dermatoses of pregnancy. These develop electively in pregnancy, and they are currently grouped into three disorders: polymorphic eruption of pregnancy, atopic eczema of pregnancy, and pemphigoid gestationis. Arguments for recognition of these are presented including detection of anti-BP180 antibodies. Follow-up and treatment depend on the precise diagnosis. Risks in fetal prognosis may occur in rare pemphigoid gestationis cases.
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Affiliation(s)
- Boutros Soutou
- Faculté de médecine, Universite saint-Joseph, 11-5076 Riad el Solh, Beirut, Lebanon; Centre Hospitalier du Nord, 100 Jdeidet Zgharta, Lebanon.
| | - Sélim Aractingi
- Faculté de médecine, Paris 5 descartes, Service de Dermatologie, Hôpital Cochin Tarnier, 89, rue d'Assas, 75006 Paris, France; Equipe Cellules souches foetales, Inserm UMR S 938 & UPMC, CDR St Antoine, 27, rue de Chaligny, 75012 Paris, France.
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37
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Marchioni Beery RM, Vaziri H, Forouhar F. Primary Biliary Cirrhosis and Primary Sclerosing Cholangitis: a Review Featuring a Women's Health Perspective. J Clin Transl Hepatol 2014; 2:266-84. [PMID: 26357630 PMCID: PMC4521232 DOI: 10.14218/jcth.2014.00024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 10/15/2014] [Accepted: 10/19/2014] [Indexed: 12/12/2022] Open
Abstract
Primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) are two major types of chronic cholestatic liver disease. Each disorder has distinguishing features and variable progression, but both may ultimately result in cirrhosis and hepatic failure. The following offers a review of PBC and PSC, beginning with a general overview of disease etiology, pathogenesis, diagnosis, clinical features, natural course, and treatment. In addition to commonly associated manifestations of fatigue, pruritus, and fat-soluble vitamin deficiency, select disease-related topics pertaining to women's health are discussed including metabolic bone disease, hyperlipidemia and cardiovascular risk, and pregnancy-related issues influencing maternal disease course and birth outcomes. This comprehensive review of PBC and PSC highlights some unique clinical considerations in the care of female patients with cholestatic liver disease.
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Affiliation(s)
- Renée M. Marchioni Beery
- Division of Internal Medicine, Department of Gastroenterology and Hepatology, University of Connecticut Health Center, Farmington, CT, USA
- Correspondence to: Renée M. Marchioni Beery, DO, Division of Internal Medicine, Department of Gastroenterology and Hepatology, 263 Farmington Avenue, Farmington, CT 06030-1845, USA. Tel: +01-860-679-3158, Fax: +01-860-679-3159. E-mail:
| | - Haleh Vaziri
- Division of Internal Medicine, Department of Gastroenterology and Hepatology, University of Connecticut Health Center, Farmington, CT, USA
| | - Faripour Forouhar
- Department of Pathology and Lab Medicine, University of Connecticut Health Center, Farmington, CT, USA
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Soutou B, Aractingi S. [Pregnancy-specific dermatoses]. Rev Med Interne 2014; 36:198-202. [PMID: 25194221 DOI: 10.1016/j.revmed.2014.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 07/31/2014] [Indexed: 11/16/2022]
Abstract
Pregnancy-specific dermatoses include polymorphic eruption of pregnancy, atopic eczema of pregnancy, and pemphigoid gestationis. Intrahepatic cholestasis of pregnancy and impetigo herpetiformis are not real pregnancy-specific dermatoses but they are important to know considering the fetal and maternal risks. Polymorphic eruption of pregnancy is a pruritic disease that usually occurs in primiparous women during the last trimester of pregnancy. Atopic eczema of pregnancy is still controversial as an entity covering conditions with eczematous lesions, prurigo, or folliculitis, and inconstantly associated with a personal history of atopy. Skin biopsy with direct immunofluorescence or search for serum anti-BPAg1 (180kD) NC16a antibodies is mandatory in pruritic dermatoses of pregnancy in order to rule out pemphigoid gestationis. Serum bile salts levels should be tested whenever a generalized pruritus develops during pregnancy in order to rule out intrahepatic cholestasis.
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Affiliation(s)
- B Soutou
- Faculté de médecine, université Saint-Joseph, 11-5076 Riad el Solh, Beyrouth, Liban; Centre hospitalier du Nord, 100, Jdeidet Zgharta, Liban.
| | - S Aractingi
- Service de dermatologie, hôpital Cochin Tarnier, faculté de médecine Paris 5 Descartes, 89, rue d'Assas, 75006 Paris, France; Inserm UMR S 938, UPMC, équipe cellules souches fœtales, CDR Saint-Antoine, 27, rue de Chaligny, 75012 Paris, France
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Woidacki K, Zenclussen AC, Siebenhaar F. Mast cell-mediated and associated disorders in pregnancy: a risky game with an uncertain outcome? Front Immunol 2014; 5:231. [PMID: 24904581 PMCID: PMC4033021 DOI: 10.3389/fimmu.2014.00231] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 05/05/2014] [Indexed: 11/13/2022] Open
Abstract
During pregnancy, the maternal organism is under the influence of tremendous endocrine as well as immunological changes as an adaptation to the implanted and developing fetus. In most cases, the maternal adaptations to pregnancy ensure both, the protection against harmful pathogens and the tolerance toward the growing semi-allogeneic fetus. However, under certain circumstances the unique hormonal milieu during pregnancy is causative of a shift into an unfavorable direction. Of particular importance are cellular disorders previous to pregnancy that involve cell types known for their susceptibility to hormones. One interesting cell type is the mast cell (MC), one of the key figures in allergic disorders. While physiological numbers of MCs were shown to positively influence pregnancy outcome, at least in mouse models, uncontrolled augmentations in quantity, and/or activation can lead to pregnancy complications. Women that have the desire of getting pregnant and been diagnosed with MC mediated disorders such as urticaria and mastocytosis or chronic inflammatory diseases in which MCs are involved, including atopic dermatitis, asthma, or psoriasis, may benefit from specialized medical assistance to ensure a positive pregnancy outcome. In the present review, we address the course of pregnancy in women affected by MC mediated or associated disorders.
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Affiliation(s)
- Katja Woidacki
- Experimental Obstetrics and Gynecology, Medical Faculty, Otto-von-Guericke University , Magdeburg , Germany
| | - Ana Claudia Zenclussen
- Experimental Obstetrics and Gynecology, Medical Faculty, Otto-von-Guericke University , Magdeburg , Germany
| | - Frank Siebenhaar
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Charité-Universitätsmedizin Berlin , Berlin , 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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Abstract
Atopic dermatitis (AD), also referred to as eczema, is one of the most frequently observed skin diseases in pregnant patients. The presentation and histopathology of this condition during pregnancy is identical to that of the non-pregnant individual. AD is a T-helper 2 dominant disease and may worsen during pregnancy, which favors this population of T-lymphocytes. AD management during pregnancy requires special precautions to avoid harming the fetus. Herein is an exploration of the different options available for the treatment of the pregnant patient with AD. The management of concomitant bacterial and viral infections is also discussed.
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Affiliation(s)
- Olubukola Babalola
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut 06032, USA
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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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Kim M, Yun Y, Kim KS, Choi I. Three cases of atopic dermatitis in pregnant women successfully treated with Korean medicine. Complement Ther Med 2013; 21:512-6. [DOI: 10.1016/j.ctim.2013.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 07/24/2013] [Indexed: 10/26/2022] Open
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Sirikudta W, Silpa-Archa N. Polymorphic eruption of pregnancy presented with targetoid lesions: a report of two cases. Case Rep Dermatol 2013; 5:138-43. [PMID: 23741213 PMCID: PMC3670623 DOI: 10.1159/000351259] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Skin lesions in pregnant women could be caused by physiologic or pathologic changes. Polymorphic eruption of pregnancy (PEP), which manifests as various types of skin lesions, is the most common pregnancy dermatosis. Thus, PEP could mimic other skin diseases related to unfavorable maternal and fetal outcomes. Main Observations Two PEP patients with targetoid lesions are presented here. One of them was a primigravida, whereas the other was a secundigravida. Both patients had singleton pregnancies and skin rash which started during the third trimester. The lesions began on the abdomen and then spread to the trunk and extremities. The face, palms, soles, and mucosa were not affected. Pruritus was observed but no other systemic symptoms were reported. Both patients delivered healthy, term infants without complications. Conclusion Targetoid lesions in PEP are an uncommon presentation, and the differential diagnosis of PEP along with other dermatoses should be considered. However, the prognosis for this type of PEP is not different from that for classic PEP.
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Affiliation(s)
- Wararat Sirikudta
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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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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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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Giugliano E, Cagnazzo E, Servello T, Mossuto E, Marci R, Patella A. Pruritic urticarial papules and plaques of pregnancy. J OBSTET GYNAECOL 2012; 32:301-2. [PMID: 22369410 DOI: 10.3109/01443615.2011.652704] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- E Giugliano
- Department of Biomedical Sciences, University of Ferrara, Ferrara, Italy.
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