1
|
Qin B, Huang Y, Zhang Y. A case of multiple soft fibromas complicated with pityriasis versicolor during pregnancy: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241274891. [PMID: 39157036 PMCID: PMC11329953 DOI: 10.1177/2050313x241274891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 06/17/2024] [Indexed: 08/20/2024] Open
Abstract
Dermatological conditions in pregnancy pose unique challenges due to concerns for maternal and fetal health. We present a case of a 32-year-old primigravida who, at 36 weeks of gestation, exhibited melanotic papules and neoplasms on her neck, chest, and breasts. Seeking evaluation for potential effects on her unborn child and breastfeeding, she presented to our dermatological outpatient facility. Physical examination revealed varied pigmented papules and verrucous proliferations. Laboratory tests and imaging were unremarkable, with histological analysis confirming fibromas and pityriasis versicolor. The patient declined treatment during pregnancy, and postpartum, spontaneous regression of lesions occurred, with complete resolution within 1 year. The child exhibited normal development, with no recurrence observed at the 2-year follow-up. This case underscores the importance of multidisciplinary care and long-term monitoring in managing dermatological manifestations during pregnancy.
Collapse
Affiliation(s)
- Bi Qin
- Institute of Traditional Chinese Medicine of Sichuan Academy of Chinese Medicine Sciences, Chengdu City, Sichuan Province, China
| | - Yuhua Huang
- Institute of Traditional Chinese Medicine of Sichuan Academy of Chinese Medicine Sciences, Chengdu City, Sichuan Province, China
| | - Yan Zhang
- Institute of Traditional Chinese Medicine of Sichuan Academy of Chinese Medicine Sciences, Chengdu City, Sichuan Province, China
| |
Collapse
|
2
|
Veronese S, Bacci PA, Garcia-Gimenez V, Canel Micheloud CC, Haro García NL, Sbarbati A. V-EMF therapy: A new painless and completely non-invasive treatment for striae gravidarum. J Cosmet Dermatol 2024; 23:2007-2014. [PMID: 38549181 DOI: 10.1111/jocd.16220] [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: 07/27/2023] [Revised: 11/06/2023] [Accepted: 01/29/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND The appearance of striae gravidarum (SG) during pregnancy is a common problem. The most common SG are abdominal striae, which can cause the greatest sequelae after pregnancy, and in the long term. There are several solutions to prevent and treat these striae, but not all are completely effective, and not without side effects. AIMS The aim of this study was to evaluate the effectiveness of a treatment that applies an electromagnetic field under vacuum (V-EMF therapy) on the abdominal SG. METHODS A retrospective analysis was conducted on the medical records of 26 women affected by abdominal SG and treated with V-EMF therapy. The results were evaluated using two different 5-point Likert Scales: one administered to the treated subjects to evaluate their satisfaction, and one to the doctors who performed the treatment, to evaluate the improvement of the striae. The presence of side effects, and the effects of sun exposure after treatment were also considered. RESULTS Only two treated subjects rated their level of satisfaction with a Score III on the Liker Scale. Everyone else expressed higher levels of satisfaction. Only one doctor rated the improvement of the striae with a Liker scale score of III. All the others reported greater improvements. No discomfort or side effects were noted either during the individual treatment sessions, or at the end of the treatment. The striae showed a newfound ability to tan. CONCLUSIONS V-EMF therapy proves to be a valid, safe, and effective treatment modality for SG.
Collapse
Affiliation(s)
- Sheila Veronese
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Pier Antonio Bacci
- Medical Centre for Vascular Diseases and Aesthetic Pathologies, Arezzo, Italy
| | - Victor Garcia-Gimenez
- Knowledge and Management in Physiological Aging Medicine Universidad Autónoma de Barcelona, Barcelona, Spain
| | | | | | - Andrea Sbarbati
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| |
Collapse
|
3
|
Sevilla A, Grichnik J. Therapeutic modulation of KIT ligand in melanocytic disorders with implications for mast cell diseases. Exp Dermatol 2024; 33:e15091. [PMID: 38711220 DOI: 10.1111/exd.15091] [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: 11/20/2023] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 05/08/2024]
Abstract
KIT ligand and its associated receptor KIT serve as a master regulatory system for both melanocytes and mast cells controlling survival, migration, proliferation and activation. Blockade of this pathway results in cell depletion, while overactivation leads to mastocytosis or melanoma. Expression defects are associated with pigmentary and mast cell disorders. KIT ligand regulation is complex but efficient targeting of this system would be of significant benefit to those suffering from melanocytic or mast cell disorders. Herein, we review the known associations of this pathway with cutaneous diseases and the regulators of this system both in skin and in the more well-studied germ cell system. Exogenous agents modulating this pathway will also be presented. Ultimately, we will review potential therapeutic opportunities to help our patients with melanocytic and mast cell disease processes potentially including vitiligo, hair greying, melasma, urticaria, mastocytosis and melanoma.
Collapse
Affiliation(s)
- Alec Sevilla
- Department of Dermatology, New York Medical College, New York, New York, USA
- Department of Internal Medicine, Lakeland Regional Health, Lakeland, Florida, USA
| | - James Grichnik
- Department of Dermatology and Cutaneous Surgery, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| |
Collapse
|
4
|
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
|
5
|
Kuzekanani M. Latest Concepts in Endodontic Management of Pregnant Patients. Int J Dent 2023; 2023:9714515. [PMID: 37899798 PMCID: PMC10611540 DOI: 10.1155/2023/9714515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/09/2023] [Accepted: 09/08/2023] [Indexed: 10/31/2023] Open
Abstract
Pregnant patients and how to manage their treatments is one of the most important challenges in endodontic practice. Endodontic treatment on pregnant women is sometimes an emergency condition to control toothache due to irreversible pulpitis and odontogenic infection. Tooth decay, oral health, local and general anesthesia, analgesics, antibiotic prescription, drug interactions, and X-ray radiation are the most important considerations that may impact treatment planning and endodontic practice in pregnancy. The aim of this article is to notify and explain the latest concepts in the endodontic management of pregnant patients.
Collapse
Affiliation(s)
- Maryam Kuzekanani
- Department of Endodontics, Kerman Dental School, Kerman University of Medical Sciences, Kerman, Iran
| |
Collapse
|
6
|
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.
| |
Collapse
|
7
|
McGuire B. Updates on Evaluation and Treatment of Common Complaints in Pregnancy. Obstet Gynecol Clin North Am 2023; 50:535-547. [PMID: 37500215 DOI: 10.1016/j.ogc.2023.03.016] [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: 07/29/2023]
Abstract
Patients experience many new and concerning symptoms during pregnancy and it is the role of the obstetric clinician to provide appropriate guidance, recommendations, and treatment options. Often times, these symptoms are related to hormonal and physiologic changes that occur and will resolve in the postpartum period. However, clinicians must be able to recognize more concerning pathologic symptoms that require further evaluation and treatment. This review provides updates on the evaluation and management of some of the common symptoms during pregnancy.
Collapse
Affiliation(s)
- Brenna McGuire
- Department of Obstetrics and Gynecology, University of New Mexico Hospital, UNM Obstetrics & Gynecology, MSC10 5580, 1 University of New Mexico, Albuquerque, NM 87131, USA.
| |
Collapse
|
8
|
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.
Collapse
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.
| |
Collapse
|
9
|
Baban F, Xie F, Lehman JS, Theiler R, Todd A, Davis DM, Johnson EF. Histopathological features of pemphigoid gestationis and polymorphic eruption of pregnancy: A blinded retrospective comparative study of 31 cases. J Cutan Pathol 2023; 50:358-363. [PMID: 36357351 DOI: 10.1111/cup.14358] [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: 07/16/2022] [Revised: 09/17/2022] [Accepted: 11/06/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Pemphigoid gestationis (PG) and polymorphic eruption of pregnancy (PEP) are pregnancy-related dermatoses. Definitive diagnosis often relies upon histopathology and direct immunofluorescence (DIF). PG is associated with fetal and neonatal risks, while PEP confers minimal risk. OBJECTIVE We aimed to compare histopathologic features to determine key differentiators. METHODS A retrospective cohort study of PG and PEP cases, with accompanying DIF, conducted from 1995 to 2020. Skin biopsies were examined independently in a blinded fashion by two dermatopathologists for a list of histopathological features. RESULTS Twenty-one cases of PG and 10 cases of PEP were identified. PG had significantly denser eosinophils than PEP (mean 155 vs. 48 cells/5 hpf; p < 0.018). PG was also noted to have eosinophilic spongiosis and eosinophils at the dermal-epidermal junction more frequently compared to PEP (80% PG vs. 10% PEP; p < 0.001). A mean cutoff value of 86 eosinophils and a mean optimal sensitivity and specificity of 81% and 83%, respectively, for eosinophils density's diagnostic power of PEP versus PG were achieved. Subepithelial separation was exclusively seen in PG (40% vs. 0%; p < 0.007). CONCLUSION Eosinophilic spongiosis, eosinophilic epitheliotropism, and dense superficial dermal eosinophils were diagnostic of PG. Given overlapping clinicopathologic features, however, DIF results with clinicopathologic correlation, remain the gold standard.
Collapse
Affiliation(s)
- Farah Baban
- Division of Anatomic and Clinical Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Fangyi Xie
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Julia S Lehman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Regan Theiler
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Austin Todd
- Department of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Dawn M Davis
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Emma F Johnson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
10
|
Gaw CE, Treat JR, Friedlaender EY, Del Pizzo J. Management of Bleeding Pyogenic Granulomas in Acute Care Settings. J Emerg Med 2022; 63:339-347. [DOI: 10.1016/j.jemermed.2022.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/29/2022] [Accepted: 04/23/2022] [Indexed: 11/07/2022]
|
11
|
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.
Collapse
|
12
|
Liu J, Ali K, Lou H, Wang L, Wu L. First-Trimester Impetigo Herpetiformis Leads to Stillbirth: A Case Report. Dermatol Ther (Heidelb) 2022; 12:1271-1279. [PMID: 35499740 PMCID: PMC9059450 DOI: 10.1007/s13555-022-00735-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/13/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Pustular psoriasis of pregnancy (PPP), also known as impetigo herpetiformis (IH), is a rare variant of generalized pustular psoriasis (GPP) in pregnancy. It typically occurs in the third trimester and is a life-threatening condition for both the pregnant mother and the fetus if not diagnosed and treated promptly. Drug-induced PPP has been reported in sporadic case reports. Here we present a case of first-trimester PPP occurring after applying drugs including chloroquine, which we consider a possible culprit triggering the disease. Case report A 29-year-old female was admitted to our department at 45 days gestation with sudden onset of fever and widespread erythematous pustules for 9 days. She had been on medications including hydroxychloroquine before onset. The eruptions and systemic symptoms were controlled with high-dose systemic steroids; however, she was detected to have a stillbirth, and underwent dilation and curettage of the uterine. At the latest follow-up about 2 years after her admission, she reported to have delivered a healthy baby about 1 month previously. Conclusions Chloroquine has potential to lead to PPP in the first trimester of pregnancy. Further studies are warranted to investigate the etiology and treatment of PPP to facilitate early recognition and optimal management of this relatively rare dermatosis in pregnancy.
Collapse
Affiliation(s)
- Jue Liu
- Department of Dermatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, No. 261, Huansha Road, Hangzhou, China
| | - Kamran Ali
- Department of Dermatology, International Education College of Zhejiang, Chinese Medical University, Hangzhou, 310006, Zhejiang, China
| | - Haiyue Lou
- Department of Dermatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, No. 261, Huansha Road, Hangzhou, China
| | - Lingling Wang
- Department of Dermatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, No. 261, Huansha Road, Hangzhou, China
| | - Liming Wu
- Department of Dermatology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, No. 261, Huansha Road, Hangzhou, China.
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Palaskar N, Bedi A, Khatu S, Poulkar C, Chaudhari N, Patokar A. The spectrum of mucocutaneous manifestation during pregnancy: An observational study of 170 pregnant women visiting a tertiary care hospital. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/2589-8302.335113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
15
|
Mysore V, Garg A. Dermatologic and cosmetic procedures in pregnancy. J Cutan Aesthet Surg 2022; 15:108-117. [PMID: 35965909 PMCID: PMC9364454 DOI: 10.4103/jcas.jcas_226_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Materials and Methods: Results:
Collapse
|
16
|
Niewozinska ZA, Dvoriankova EV, Tkachenko OI, Korsunskaya IM. Atopic skin lesions in pregnant women: how to help patients. CONSILIUM MEDICUM 2021. [DOI: 10.26442/20751753.2021.12.201257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Many pregnant women experience skin symptoms caused by immunological, metabolic or other changes that occur in their body during pregnancy. One of the most common complaints of pregnant women is itchy skin. In about 20% of cases, itching in pregnant women is associated with atopic skin lesions. Histologically, these lesions are indistinguishable from atopic dermatitis, which also tends to worsen during pregnancy. It is believed that these lesions are due to increased production of Th2 cytokines (interleukin-4 and -10) in the body of a pregnant woman. Topical glucocorticosteroids and skin care products are best treatments for atopic skin lesions of pregnant women and exacerbation of atopic dermatitis. In cases of limited rashes or mild dermatitis, only care products with a strong moisturizing effect can be used. Using moisturizers can help minimize itching and skin discomfort. One of these agents that we use in practice is XeraCalm A.D Lipid-Replenishing cream, the unique formula of which not only has a regenerating and antipruritic effect, but also enhances the natural immunity of the skin.
Collapse
|
17
|
Genovese G, Moltrasio C, Cassano N, Maronese CA, Vena GA, Marzano AV. Pustular Psoriasis: From Pathophysiology to Treatment. Biomedicines 2021; 9:biomedicines9121746. [PMID: 34944562 PMCID: PMC8698272 DOI: 10.3390/biomedicines9121746] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 12/21/2022] Open
Abstract
Pustular psoriasis (PP) is a clinicopathological entity encompassing different variants, i.e., acute generalized PP (GPP), PP of pregnancy (impetigo herpetiformis), annular (and circinate) PP, infantile/juvenile PP, palmoplantar PP/palmoplantar pustulosis, and acrodermatitis continua of Hallopeau (ACH), which have in common an eruption of superficial sterile pustules on an erythematous base. Unlike psoriasis vulgaris, in which a key role is played by the adaptive immune system and interleukin (IL)-17/IL-23 axis, PP seems to be characterized by an intense inflammatory response resulting from innate immunity hyperactivation, with prominent involvement of the IL-36 axis. Some nosological aspects of PP are still controversial and debated. Moreover, owing to the rarity and heterogeneity of PP forms, data on prognosis and therapeutic management are limited. Recent progresses in the identification of genetic mutations and immunological mechanisms have promoted a better understanding of PP pathogenesis and might have important consequences on diagnostic refinement and treatment. In this narrative review, current findings in the pathogenesis, classification, clinical features, and therapeutic management of PP are briefly discussed.
Collapse
Affiliation(s)
- Giovanni Genovese
- Dermatology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.G.); (C.M.); (C.A.M.)
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, 20122 Milan, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.G.); (C.M.); (C.A.M.)
- Department of Medical Surgical and Health Sciences, University of Trieste, 34137 Trieste, Italy
| | - Nicoletta Cassano
- Dermatology and Venereology Private Practice, 76121 Barletta, Italy; (N.C.); (G.A.V.)
| | - Carlo Alberto Maronese
- Dermatology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.G.); (C.M.); (C.A.M.)
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, 20122 Milan, Italy
| | - Gino Antonio Vena
- Dermatology and Venereology Private Practice, 76121 Barletta, Italy; (N.C.); (G.A.V.)
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.G.); (C.M.); (C.A.M.)
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, 20122 Milan, Italy
- Correspondence:
| |
Collapse
|
18
|
Allameh F, Javadi A, Dadkhahfar S, Naeeji Z, Moridi A, Tadayon N, Alahyari S. A Systematic Review of Elective Laser Therapy during Pregnancy. J Lasers Med Sci 2021; 12:e50. [PMID: 34733773 DOI: 10.34172/jlms.2021.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/26/2021] [Indexed: 12/15/2022]
Abstract
Introduction: Currently, lasers are used to treat many diseases and their complications. However, the use of lasers in pregnant patients is still controversial. Methods: In this review, the application of lasers in the fields of urology, surgery, obstetrics, dermatology, and musculoskeletal disorders is evaluated. The following keywords were used to search through PubMed, Google Scholar, and Scopus: pregnancy, laser, urolithiasis, endovenous laser ablation (EVLA) or treatment, leg edema, varicose vein, venous insufficiencies, hair removal, pigmentation, telangiectasia, vascular lesions, Q switch laser, diode laser, holmium, holmium-YAG laser, erbium laser and Pulsed dye laser, low-level laser therapy, high-intensity laser therapy, pain, musculoskeletal disorders, twin to twin transfusion syndrome (TTTS), amnioreduction, and safety. Results: Totally, 147 articles were found, and their abstracts were evaluated; out of 53 articles extracted, 14 articles were about dermatology, 24 articles were about urology, 12 articles were about obstetrics and gynecology, 10 articles were about musculoskeletal disorders and three articles were related to surgery. Conclusion: Laser therapy can be used as a safe treatment for urolithiasis, skin diseases, TTTS and varicose veins of the lower extremities. However, the use of laser therapy for musculoskeletal disorders during pregnancy is not recommended due to lack of evidence, and also we cannot recommend endovenous ablation.
Collapse
Affiliation(s)
- Farzad Allameh
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Javadi
- Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahar Dadkhahfar
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Naeeji
- Clinical Research Development Center, Mahdiyeh Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Moridi
- Department of Gynecology and Obstetrics, Mahdiye Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niki Tadayon
- Department of General and Vascular Surgery, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sam Alahyari
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
19
|
Barnawi AM, Barnawi GM, Alamri AM. Women's Health: Most Common Physiologic and Pathologic Cutaneous Manifestations During Pregnancy. Cureus 2021; 13:e16539. [PMID: 34430147 PMCID: PMC8378782 DOI: 10.7759/cureus.16539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 11/25/2022] Open
Abstract
Pregnant women are susceptible to various physiological and pathological skin and body habitus changes during pregnancy due to the alterations that occur in a multi-organ-system fashion. Pregnancy can be the onset of different dermatological diseases and can exacerbate pre-existing cutaneous conditions. Moreover, management of dermatologic diseases during pregnancy might be challenging as it requires special attention to both mother and fetus. We aim to assess the most common cutaneous changes and conditions that occur during pregnancy by reviewing the previous studies conducted on this subject. The medical literature was explored through PubMed and Google scholar databases starting from 2015 to 2021. The included searching terms were a combination of "Cutaneous changes and pregnancy," Dermal conditions and pregnancy," Pregnancy-associated dermal conditions," and "Dermatological changes and pregnant women." The inclusion criteria included original articles conducted on pregnant women and full text- articles. A total of 134 articles were obtained, 11 articles were eligible for the inclusion criteria. The 11 studies included a total number of 14,813 pregnant women and covered four countries. The most common cutaneous conditions experienced by pregnant women were primarily physiological skin changes, pregnancy-specific dermatopathologies, and exacerbations of other common skin diseases. All in all, this systematic review concluded that pregnant women are more vulnerable to various dermatological conditions during pregnancy. These changes were more commonly physiological such as hyperpigmentations. However, pathological pregnancy-specific skin conditions and exacerbations of pre-existing dermatoses like atopic eruptions were also reported.
Collapse
Affiliation(s)
- Azhar M Barnawi
- Family Medicine, Armed Forces Hospital, Prince Mansour Military Hospital for Community Medicine, Taif, SAU
| | - Ghassan M Barnawi
- Dermatology, College of Medicine at King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah, SAU
| | - Awadh M Alamri
- Dermatology, College of Medicine at King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah, SAU
| |
Collapse
|
20
|
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
|
21
|
Kutlubay Z, Cesur SK, Aşkın Ö, Tüzün Y. The color of skin: brown diseases of the skin, nails, and mucosa. Clin Dermatol 2020; 37:487-506. [PMID: 31896404 DOI: 10.1016/j.clindermatol.2019.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Brown diseases comprise disorders leading to hyperpigmentation in skin and nails. Melasma is an acquired skin disorder that is characterized by brownish macules that typically occur on the face. Schamberg disease, also known as progressive pigmented purpura, is characterized by brown pigmentation with pepper spots on their edges. We summarize the epidemiology, pathogenesis, histologic features, and treatment choices for additional brown diseases, including melasma, pigmented purpuric dermatoses, postinflammatory hyperpigmentation, drug-induced hyperpigmentation, and pigmentations due to systemic or physiologic conditions.
Collapse
Affiliation(s)
- Zekayi Kutlubay
- Department of Dermatology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
| | | | - Özge Aşkın
- Department of Dermatology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Yalçın Tüzün
- Department of Dermatology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| |
Collapse
|
22
|
Utilization of Laser Therapy During Pregnancy: A Systematic Review of the Maternal and Fetal Effects Reported From 1960 to 2017. Dermatol Surg 2019; 45:818-828. [PMID: 30998530 DOI: 10.1097/dss.0000000000001912] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Due to concerns regarding maternal and fetal safety and the absence of evidence to the contrary, laser treatment during pregnancy has traditionally been limited to situations of absolute necessity. OBJECTIVE This review seeks to examine the available evidence to determine the safety of laser therapy during pregnancy. METHODS Medical databases were searched for relevant reports from all specialties regarding the use of lasers during pregnancy from 1960 to 2017. A legal case review was also performed. RESULTS Twenty-two publications in the literature reported the use of various laser wavelengths in 380 pregnant women during all trimesters. Other than 1 case of premature rupture of membranes questionably related to the laser treatment, there were no cases of maternal or fetal morbidity or mortality, premature labor, or identifiable fetal stress. CONCLUSION The available evidence, limited to low evidence level case reports and series, indicates cutaneous laser treatment during pregnancy is safe for both mother and fetus. Furthermore, laser physics and optics dictate there should theoretically be no risk of fetal laser exposure from commonly used cutaneous lasers.
Collapse
|
23
|
Ramakrishnan H, Noorullah A, Venugopal L. A Clinical Report of Solitary Gingival Overgrowth in a Young Female Patient. J Pharm Bioallied Sci 2019; 11:S491-S494. [PMID: 31198394 PMCID: PMC6555347 DOI: 10.4103/jpbs.jpbs_8_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pyogenic granuloma is a type of inflammatory hyperplasia. The term “inflammatory hyperplasia” is used to describe nodular growths of oral mucosa that histologically contain inflamed fibrous and granulation tissues. It is nonneoplastic. It is predominant in second decade of life in young adult females. Oral pyogenic granuloma is the most common gingival tumor with a striking predilection to gingiva. About one-third of the lesions occur following trauma. Poor oral hygiene may be a precipitating factor as 75% of all cases show calculus or foreign material in gingival sulcus. Lesions are more common in maxillary than mandibular gingiva; lesions are more common on the facial aspect of gingiva than gingival aspect. Clinically, pyogenic granuloma is a smooth, lobulated, exophytic lesion seen as small, red, and erythematous papules on a pedunculated or sessile base that is usually hemorrhagic. Clinical development of the lesion is slow, asymptomatic, and painless but may also grow rapidly; surface is characteristically ulcerated and friable, covered by yellow, fibrinous membrane with its color ranging from pink to red to purple depending on the age of the lesion. Pyogenic granuloma develops in about 5% of pregnancy, called as “pregnancy tumor’’ or “granuloma gravidarum.” Hormonal imbalance in pregnancy exaggerates the body’s response to bacterial irritation. Sometimes, pregnancy gingivitis may show a tendency for localized hyperplasia, which is called “pregnancy granuloma.” Generally, it appears in about second-to-third month of pregnancy. Although pyogenic granuloma is a nonneoplastic growth in the oral cavity, proper diagnosis, prevention, management, and treatment of the lesion is very important. Excisional surgery is the treatment of choice whereas cryosurgery, excision by Nd:YAG laser, and sclerotherapy are alternative therapies. Though pyogenic granuloma in pregnancy is because of the effect of sex hormonal imbalances, taking careful oral hygiene measures is important to avoid recurrence of the lesion. This article is a case report of a 22-year-old female patient with pyogenic granuloma in the buccal aspect of maxillary gingiva managed by surgical excision.
Collapse
Affiliation(s)
- Hemalatha Ramakrishnan
- Department of Periodontics, Karpaga Vinayaga Institute of Dental Sciences, Kanchipuram, Tamil Nadu, India
| | - Anisa Noorullah
- Department of Oral Medicine and Radiology, Karpaga Vinayaga Institute of Dental Sciences, Kanchipuram, Tamil Nadu, India
| | - Leelarani Venugopal
- Department of pedodontics, Karpaga Vinayaga Institute of Dental Sciences, Kanchipuram, Tamil Nadu, India
| |
Collapse
|
24
|
Just U, Hinterhuber G, Knobler R, Neumann R. A potassium-titanyl-phosphate laser is an efficacious tool in the treatment of pyogenic granulomas. A retrospective study in 28 patients. Photochem Photobiol Sci 2019; 18:343-348. [PMID: 30378630 DOI: 10.1039/c8pp00264a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Pyogenic granuloma is a common benign vascular lesion of the skin and mucosa prone to ulceration and bleeding. Current therapeutic approaches include surgical excision, removal by means of electro caustic therapy, cryotherapy, and ablation with CO2 or vascular lasers. The purpose of this study was to investigate the efficacy of a 532 nm potassium-titanyl-phosphate laser (KTP-laser) for the treatment of pyogenic granulomas in terms of efficacy, advantages in clinical outcome, technique and associated side effects. METHODS In this retrospective study we report on the response of 28 consecutive patients with pyogenic granulomas at multiple locations on the skin after having been treated with a 532 nm KTP laser (532 nm AuraTM Star Pulse laser, Laserscope, CA, USA). Treatment was performed with a 2 mm handpiece and energy fluences of 35-60 J cm-2 and a laser pulse width of 50 ms or with a 1 mm handpiece and energy fluences of 200-240 J cm-2 and a laser pulse width of 50 ms. All patients were treated on an outpatient basis at the department of dermatology, Medical University of Vienna, Austria. RESULTS In all of the 28 patients treated, we were able to demonstrate both symptomatic and clinical clearing of the lesions with excellent cosmetic results after the treatment. In 25 of the 28 patients a single treatment was sufficient to obtain optimal results. In three patients a second treatment session was required due to the recurrence of the lesion. The procedure required only local anesthesia, and postoperative care was limited to the application of a topical antibiotic ointment. No postoperative complications such as increased pain or wound infection and only minimal scarring were observed. CONCLUSIONS This experience with excellent patient satisfaction suggests that treatment of pyogenic granulomas with the KTP laser is a safe, effective, and reasonable alternative to conventional therapy. As with many other limited interventions with this laser technology, the advantages include minimal postoperative pain, conservative site-specific minimally invasive surgeries and a very satisfactory cosmetic result with a high acceptance rate on the side of the patients.
Collapse
Affiliation(s)
- Ulrike Just
- Department of Dermatology, Medical University of Vienna, Austria
| | | | - Robert Knobler
- Department of Dermatology, Medical University of Vienna, Austria
| | - Reinhard Neumann
- Department of Dermatology, Medical University of Vienna, Austria
| |
Collapse
|
25
|
Kar S, Sonkusale P, Yadav N, Bonde P. Pregnancy-associated hyperkeratosis of the nipple/areola. JOURNAL OF MAHATMA GANDHI INSTITUTE OF MEDICAL SCIENCES 2019. [DOI: 10.4103/jmgims.jmgims_62_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
26
|
Dominguez-Serrano AJ, Quiroga-Garza A, Jacobo-Baca G, De La Fuente-Villarreal D, Gonzalez-Ramirez RA, Vazquez-Barragan MA, Guzman-Lopez A, Elizondo-Omaña RE, Guzman-Lopez S. Polymorphic eruption of pregnancy in Mexico. Int J Dermatol 2018; 58:259-262. [PMID: 30549007 DOI: 10.1111/ijd.14337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 11/02/2018] [Accepted: 11/19/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Currently, the exact incidence of Polymorphic Eruption of Pregnancy (PEP) in the Mexican population is unknown. PEP tends to manifest in the abdomen, primarily in the stretch marks caused by distension. It is characterized by severely pruritic urticarial-like papules that converge in plaques, extending to the buttocks and proximal thighs. Our study determined its incidence, along with other common dermatoses in pregnancy. METHODS Patients between 14 and 45 years of age were evaluated. In each patient, a complete medical history and physical examination was performed with emphasis on skin and adnexa. Patients were followed until the end of their pregnancy. RESULTS A total of 217 women were included. PEP was identified in three patients (1.38%), all primigravida, with single fetus pregnancy, and all concluded their pregnancy by vaginal delivery. The neonates were 2 females and 1 male. No other gestational pathologies were identified. CONCLUSIONS We identified a higher incidence of PEP than reported, without association to complications or need for medical management. There may be an association between high maternal weight and the presence of PEP, however a larger sample is needed.
Collapse
Affiliation(s)
| | - Alejandro Quiroga-Garza
- Facultad de Medicina, Human Anatomy Department, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Guillermo Jacobo-Baca
- Facultad de Medicina, Human Anatomy Department, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | | | - Roger A Gonzalez-Ramirez
- Facultad de Medicina, Departamento de Introduccion a la Clinica, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico.,Dermatology, Escuela Nacional de Medicina, Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Mexico
| | - Miguel A Vazquez-Barragan
- Obstetrics and Gynecology Department, Universidad Autonoma de Nuevo Leon, Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Monterrey, Mexico
| | - Abel Guzman-Lopez
- Obstetrics and Gynecology Department, Universidad Autonoma de Nuevo Leon, Hospital Universitario "Dr. Jose Eleuterio Gonzalez", Monterrey, Mexico
| | - Rodrigo E Elizondo-Omaña
- Facultad de Medicina, Human Anatomy Department, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Santos Guzman-Lopez
- Facultad de Medicina, Human Anatomy Department, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| |
Collapse
|
27
|
Kroumpouzos G, Bercovitch L. Ethics of esthetic procedures in pregnancy. Int J Womens Dermatol 2018; 4:194-197. [PMID: 30627616 PMCID: PMC6322152 DOI: 10.1016/j.ijwd.2018.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 11/23/2022] Open
Affiliation(s)
- G. Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil
| | - L. Bercovitch
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island
| |
Collapse
|
28
|
Altan Ferhatoğlu Z, Göktay F, Yaşar Ş, Aytekin S. Morphology, growth rate, and thickness of the nail plate during the pregnancy. Int J Dermatol 2018; 57:1253-1258. [DOI: 10.1111/ijd.14152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/14/2018] [Accepted: 06/22/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Zeynep Altan Ferhatoğlu
- Department of Dermatology and Venereology; Haydarpaşa Numune Training and Research Hospital; University of Health Sciences; İstanbul Turkey
| | - Fatih Göktay
- Department of Dermatology and Venereology; Haydarpaşa Numune Training and Research Hospital; University of Health Sciences; İstanbul Turkey
| | - Şirin Yaşar
- Department of Dermatology and Venereology; Haydarpaşa Numune Training and Research Hospital; University of Health Sciences; İstanbul Turkey
| | - Sema Aytekin
- Department of Dermatology and Venereology; Haydarpaşa Numune Training and Research Hospital; University of Health Sciences; İstanbul Turkey
| |
Collapse
|
29
|
Moon J, Lee JS, Park HS, Yoon HS, Cho S. Eccrine Poroma with Rapid Growth during Pregnancy: A Case Report and Review of the Literature. Ann Dermatol 2018; 30:222-225. [PMID: 29606822 PMCID: PMC5839896 DOI: 10.5021/ad.2018.30.2.222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 07/18/2017] [Accepted: 07/25/2017] [Indexed: 11/10/2022] Open
Abstract
Eccrine poroma is a benign solitary tumor with acrosyringeal differentiation that usually occurs on the sole or either side of the foot. Rapid growth of eccrine poroma during pregnancy has rarely been reported. We demonstrate a unique case of a 37-year-old pregnant woman who suffered from enlarged eccrine poroma on her left palm, which was tiny for 10 years but suddenly grew to a size of bean-sized reddish brown colored, pedunculated mass during pregnancy. The patient denied a previous history of trauma or infection to the lesion. Histopathologic findings with a shave biopsy were consistent with eccrine poroma. After the tumor was completely removed by the shave biopsy, no recurrence was noted for 5 months.
Collapse
Affiliation(s)
- Jungyoon Moon
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Ji Su Lee
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Hyun-Sun Park
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Hyun-Sun Yoon
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Soyun Cho
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| |
Collapse
|
30
|
Kannambal K, Tharini GK. A Screening Study on Dermatoses in Pregnancy. J Clin Diagn Res 2017; 11:WC01-WC05. [PMID: 28658887 PMCID: PMC5483789 DOI: 10.7860/jcdr/2017/27207.9907] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/16/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Pregnancy produces many cutaneous changes, some of which are specifically related to pregnancy (dermatoses of pregnancy), some are modifiable by pregnancy and others that are common are named physiologic. These physiologic skin changes, usually do not impair the health of the mother or the fetus but some of them can be cosmetically significant and of importance to the dermatologist. AIM The present study was undertaken to find out the prevalence of the physiological and pathological skin changes in pregnancy, and to correlate the prevalence of the major cutaneous changes and diseases in relation to different trimesters of pregnancy and with gravidity. MATERIALS AND METHODS A cross-sectional study was conducted during the period of August 2008 to August 2010. Ethical clearance was sought from Institutional Ethical Committee. Five hundred pregnant women were randomly selected, irrespective of the duration of pregnancy and gravidity. Detailed history and complete dermatological examination was done. Results were tabulated and analysed. Statistical analysis was done by Fisher's exact test and Chi square test. RESULTS Physiological skin changes were seen in 94.8% of cases, with pigmentary changes being more common (90.8%). Specific dermatoses of pregnancy were observed in 14% of cases with pruritus gravidarum being the most common (10.4%). Prevalence of infection was found to 30.8% with fungal infection being the most common (23.8%). Exacerbations of systemic lupus erythematosus and neurofibromatosis was observed. Pigmentary changes, striae gravidarum and specific dermatoses of pregnancy were observed in statistically significant proportion in primigravidas and during third trimester. CONCLUSION This study emphasizes that the prevalence of physiological skin changes (94.8%) was much higher than specific dermatoses (14%), stressing the fact that in most instances, the skin problems during pregnancy needs only reassurance. But meticulous observation and examination should be done, as pregnancy can influence many dermatological diseases and infections.
Collapse
Affiliation(s)
- K. Kannambal
- Lecturer, Department of Dermatology, Venereology and Leprosy, Rajah Muthaiah Medical College, Annamalai University, Chidambaram, Tamil Nadu, India
| | - GK Tharini
- Associate Professor, Department of Dermatology, Venereology and Leprosy, Villupuram Medical College, Villupuram, Tamil Nadu, India
| |
Collapse
|
31
|
Kim EH. Pruritic Urticarial Papules and Plaques of Pregnancy Occurring Postpartum Treated with Intramuscular Injection of Autologous Whole Blood. Case Rep Dermatol 2017; 9:151-156. [PMID: 28559815 PMCID: PMC5437438 DOI: 10.1159/000473874] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 03/31/2017] [Indexed: 11/19/2022] Open
Abstract
Pruritic urticarial papules and plaques of pregnancy (PUPPP) is one of the most common diseases associated with pregnancy. In most cases, the skin lesions develop in the third trimester of primigravidas. There are no systemic alterations seen in PUPPP; however, most patients report severe pruritus. A 34-year-old woman presented 1 week postpartum with typical clinical features of PUPPP. The patient showed good response to intramuscular injection of autologous whole blood with no adverse effects to the patient or her baby. Presentation of PUPPP in the postpartum period is rare. Conservative management with topical corticosteroids and oral antihistamines is commonly used to relieve pruritus. In severe cases, skin lesions and symptoms are controlled with a brief course of systemic corticosteroids. Investigation of new treatment options has been limited by patient concerns about the negative effects of medication on the fetus or breastfeeding. Intramuscular injection of autologous whole blood could be an alternative treatment option for PUPPP, especially for women who worry about the use of medications during pregnancy or breastfeeding.
Collapse
Affiliation(s)
- En Hyung Kim
- Department of Dermatology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Cheonan, Republic of Korea
| |
Collapse
|
32
|
Delorenze LM, Branco LG, Cerqueira LF, Vasques WB, Salles SDAN, Vilar EG. Pruritic folliculitis of pregnancy. An Bras Dermatol 2017; 91:66-68. [PMID: 28300898 PMCID: PMC5324997 DOI: 10.1590/abd1806-4841.20164735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 07/20/2015] [Indexed: 11/21/2022] Open
Abstract
Pruritic folliculitis of pregnancy is a rare disease of unknown etiology. It
occcurs primarily during pregnancy, usually with spontaneous resolution
postpartum. It is characterized by a benign dermatosis, with papular and
pustular follicular lesions that first appear on the torso and occasionally
spread throughout the body. We report the case of a patient in the 27th week of
pregnancy, with a two-month evolution of pruritic and papular erythematous
lesions on her lower back. Differential diagnosis includes other
pregnancy-specific dermatoses: gestational pemphigoid, pruritic urticarial
papules and plaques of pregnancy (PUPPP), prurigo of pregnancy, and (PUPPP) and
prurigo of pregancy. Histopathological tests showed changes consistent with
pruritic folliculitis of pregnancy. This case is relevant due to its rare nature
and its clinical and histopathological characteristics.
Collapse
|
33
|
Jeon C, Agbai O, Butler D, Murase J. Dermatologic conditions in patients of color who are pregnant. Int J Womens Dermatol 2017; 3:30-36. [PMID: 28492052 PMCID: PMC5418956 DOI: 10.1016/j.ijwd.2017.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 02/06/2017] [Accepted: 02/08/2017] [Indexed: 01/16/2023] Open
Abstract
Certain dermatoses that present during pregnancy have a predilection for populations with skin of color (SOC). Additionally, certain systemic diseases such as systemic lupus erythematosus tend to be more aggressive during pregnancy and confer worse prognoses in women with SOC. The purpose of this review is to highlight the unique implications of selected diseases during pregnancy as it relates to SOC. Dermatologists should be vigilant for the unique clinical variations of dermatological conditions in patients of color who are pregnant to ensure correct diagnoses and optimize treatment outcomes.
Collapse
|
34
|
Abstract
Pustular psoriasis of pregnancy is a rare, autoimmune inflammatory disorder, which can be associated with adverse maternal and fetal outcomes. Although recovery of the skin lesions after the delivery is the rule, some patients need immunosuppressive treatment mainly with corticosteroids. We describe a patient with pustular psoriasis of pregnancy who needed treatment with cyclosporine for resistant skin psoriasis and systemic inflammatory response.
Collapse
|
35
|
|
36
|
Brandão P, Sousa-Faria B, Marinho C, Vieira-Enes P, Melo A, Mota L. Polymorphic eruption of pregnancy: Review of literature. J OBSTET GYNAECOL 2016; 37:137-140. [PMID: 27960565 DOI: 10.1080/01443615.2016.1225019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Polymorphic Eruption of Pregnancy (PEP) is one of the most common dermatosis related to pregnancy. PEP usually consists of pruritic papules and plaques appearing in the third trimester of pregnancy. It is more common in primigravidae and twin pregnancies. Although not associated with poorer foetal or maternal outcomes, it may be hard for pregnant women to endure. The diagnosis is easy if suspected, though sometimes it may be hard to distinguish from other dermatosis such as atopic eczema of pregnancy, pemphigoid gestationis or dermatitis. Topical treatment with emollients and low-medium potency steroids is usually effective but systemic steroid treatment may be required. PEP is self-limiting and resolves days or weeks after the first appearance or after delivery. In this article, the authors aim to review the literature published from 2000 onwards regarding the subject, either in English or Portuguese.
Collapse
Affiliation(s)
- Pedro Brandão
- a Department of Obstetrics and Gynaecology , Centro Hospitalar Tâmega e Sousa, Hospital Padre Américo , Penafiel , Portugal
| | - Bárbara Sousa-Faria
- a Department of Obstetrics and Gynaecology , Centro Hospitalar Tâmega e Sousa, Hospital Padre Américo , Penafiel , Portugal
| | - Carla Marinho
- a Department of Obstetrics and Gynaecology , Centro Hospitalar Tâmega e Sousa, Hospital Padre Américo , Penafiel , Portugal
| | - Pedro Vieira-Enes
- a Department of Obstetrics and Gynaecology , Centro Hospitalar Tâmega e Sousa, Hospital Padre Américo , Penafiel , Portugal
| | - Anabela Melo
- a Department of Obstetrics and Gynaecology , Centro Hospitalar Tâmega e Sousa, Hospital Padre Américo , Penafiel , Portugal
| | - Lurdes Mota
- a Department of Obstetrics and Gynaecology , Centro Hospitalar Tâmega e Sousa, Hospital Padre Américo , Penafiel , Portugal
| |
Collapse
|
37
|
Prieto-Torres L, Gracia-Cazaña T, Sánchez-Salas MP, Muñiz G, Padgett E, Gilaberte Y. Unilateral progressive telangiectatic eruption with a metameral distribution during pregnancy. J OBSTET GYNAECOL 2016; 37:377-378. [PMID: 27919175 DOI: 10.1080/01443615.2016.1244813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Lucia Prieto-Torres
- a Department of Dermatology , University Hospital "Lozano Blesa" Zaragoza , Spain
| | | | | | - Gorka Muñiz
- c Department of Pathology , Hospital de Barbastro , Barbastro , Spain
| | - Esteban Padgett
- d Aragon Health Service , Hospital de Barbastro , Barbastro , Spain
| | | |
Collapse
|
38
|
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.
Collapse
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
| |
Collapse
|
39
|
Benjegerdes KE, Hyde K, Kivelevitch D, Mansouri B. Pustular psoriasis: pathophysiology and current treatment perspectives. PSORIASIS (AUCKLAND, N.Z.) 2016; 6:131-144. [PMID: 29387600 PMCID: PMC5683122 DOI: 10.2147/ptt.s98954] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Psoriasis vulgaris is a chronic inflammatory disease that classically affects skin and joints and is associated with numerous comorbidities. There are several clinical subtypes of psoriasis including the uncommon pustular variants, which are subdivided into generalized and localized forms. Generalized forms of pustular psoriasis include acute generalized pustular psoriasis, pustular psoriasis of pregnancy, and infantile and juvenile pustular psoriasis. Localized forms include acrodermatitis continua of Hallopeau and palmoplantar pustular psoriasis. These subtypes vary in their presentations, but all have similar histopathologic characteristics. The immunopathogenesis of each entity remains to be fully elucidated and some debate exists as to whether these inflammatory pustular dermatoses should be classified as entities distinct from psoriasis vulgaris. Due to the rarity of these conditions and the questionable link to the common, plaque-type psoriasis, numerous therapies have shown variable results and most entities remain difficult to treat. With increasing knowledge of the pathogenesis of these variants of pustular psoriasis, the development and use of biologic and other immunomodulatory therapies holds promise for the future of successfully treating pustular variants of psoriasis.
Collapse
Affiliation(s)
| | - Kimberly Hyde
- Texas A&M Health Science Center College of Medicine, Round Rock
| | | | - Bobbak Mansouri
- Texas A&M Health Science Center College of Medicine, Temple
- Department of Dermatology, Scott and White Hospital, Texas A&M Health Science Center College of Medicine, Temple, TX, USA
| |
Collapse
|
40
|
Abstract
Background: Women comprise half of all psoriasis patients and because the majority of psoriasis cases present before age 40 the disease affects women who may become pregnant. Information regarding the heritability of psoriasis can be used in counseling patients who inquire about the potential risk to their children. Patients with psoriasis who become pregnant will likely notice an associated improvement of their symptoms if any change is noted at all. Objective: Because of potential fetal effects, the treatment of chronic psoriasis in pregnancy involves prudent consideration of whether the severity of the disease warrants treatment and selection of the safest treatments available. Conclusion: Topical corticosteroids and topical calcipotriene as well as topical anthralin and topical tacrolimus appear to be safe choices for control of localized psoriasis in pregnancy. UVB is the safest treatment for extensive psoriasis during pregnancy, particularly when topical application of other agents is not practical. Short-term use of cyclosporine during pregnancy is probably the safest option for management of severe psoriasis that has not responded to topical or UVB treatment.
Collapse
Affiliation(s)
- Amanda E. Tauscher
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Alan B. Fleischer
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Kathy C. Phelps
- Department of Pharmacy, North Carolina Baptist Hospital, Winston-Salem, North Carolina, USA
| | - Steven R. Feldman
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| |
Collapse
|
41
|
Gastrointestinal Pyogenic Granuloma (Lobular Capillary Hemangioma): An Underrecognized Entity Causing Iron Deficiency Anemia. Case Rep Gastrointest Med 2016; 2016:4398401. [PMID: 27403353 PMCID: PMC4925958 DOI: 10.1155/2016/4398401] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 05/19/2016] [Accepted: 05/22/2016] [Indexed: 11/17/2022] Open
Abstract
Pyogenic granuloma (PG), more accurately known as lobular capillary hemangioma, is a benign vascular tumor that usually occurs in the skin or oral mucosa. This lesion is rarely reported in the gastrointestinal tract but is known to bleed if not resected. We herein describe a case series with the clinical, endoscopic, and histologic findings of four cases of gastrointestinal PG at our institution. In addition, we provide a review of the literature and summation of all reported cases of PG specific to the gastrointestinal tract. Based on our experience, we suggest that the actual incidence of gastrointestinal PG may in fact be higher than reported because PG can be unrecognized or improperly diagnosed. It is important for the clinician to properly recognize this lesion as a source of anemia and its propensity to bleed during biopsy or resection.
Collapse
|
42
|
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]
|
43
|
|
44
|
Abstract
Physiologic alterations of the oral and vulvovaginal mucosal surfaces result from the profound hormonal and immunologic changes of gestation. High estrogen levels are responsible for the vascular changes noted on mucosal surfaces. Gingival hyperemia and edema, gingivitis and pyogenic granuloma are the most common alterations of the oral mucosa during gestation. Physiologic changes of the vulvovaginal area are mainly of vascular nature, and include among others varicose veins. The oral and vulvovaginal mucosal surfaces can be affected by diseases that can worsen or develop in pregnancy. Oral lesions are encountered in a large spectrum of diseases including aphthosis, pemphigus vulgaris, systemic lupus, and Behçet disease. Pregnancy dermatoses such as impetigo herpetiformis and gestational pemphigoid can exceptionally affect the oral mucosa. Infections of the vulvovaginal region by Candida species, Trichomononas vaginalis, human papilloma virus, and herpes simplex virus have been associated with fetal risks. The dermatologist, obstetric medicine physician, and neonatologist should be familiar with the above physiologic changes as well as maternal/fetal risks relevant to disease affecting these mucosal surfaces during gestation.
Collapse
Affiliation(s)
- Marcia Ramos-E-Silva
- Sector of Dermatology and Post-Graduation Course, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Natalia Regina Martins
- Sector of Dermatology and Post-Graduation Course, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - George Kroumpouzos
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| |
Collapse
|
45
|
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
|
46
|
Self-assessment of striae gravidarum prophylaxis. Postepy Dermatol Alergol 2016; 32:459-64. [PMID: 26755911 PMCID: PMC4697027 DOI: 10.5114/pdia.2015.56100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 02/10/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction Striae are the most frequently occurring pathology of connective tissue during pregnancy. According to the statistical data, 70–90% of women suffer from striae gravidarum. Aim To assess effectiveness of topical products and massage used by pregnant women in striae gravidarum prophylaxis. Material and methods The questionnaire study was conducted among 299 women who were maximum 6 months after delivery at term. The questionnaire included questions concerning age, occurrence of striae gravidarum during pregnancy, their location, week of gestation when the lesions appeared and used striae prophylaxis as well as its effectiveness in respondents’ opinion. Results Analysis of the correlation between striae gravidarum occurrence and use of different types of cosmetics showed that this kind of prophylaxis is effective when applied at least twice a day (63.7% vs. 77.6%). No correlation between the type of cosmetics and presence of striae was observed (p > 0.05). Conclusions Use of prophylactic measures like skin emollients and oils with the appropriate frequency significantly reduces the risk of striae gravidarum occurrence.
Collapse
|
47
|
Fischer T, Grab D, Grubert T, Hantschmann P, Kainer F, Kästner R, Kentenich C, Klockenbusch W, Lammert F, Louwen F, Mylonas I, Pildner von Steinburg S, Rath W, Schäfer-Graf UM, Schleußner E, Schmitz R, Steitz HO, Verlohren S. Maternale Erkrankungen in der Schwangerschaft. FACHARZTWISSEN GEBURTSMEDIZIN 2016. [PMCID: PMC7158353 DOI: 10.1016/b978-3-437-23752-2.00017-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
48
|
Abstract
Physicians may often mistake normal physiological skin changes in pregnancy for pathologic changes, so being able to recognize the skin manifestations unique to pregnancy is of the utmost importance to avoid unnecessary testing and stress for the obstetric patient. Most physiological skin changes will resolve postpartum, so reassurance and expectant management is indicated in almost all cases.
Collapse
|
49
|
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.
Collapse
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.
| |
Collapse
|
50
|
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
|