Clinician's Photo Guide to Recognizing and Treating Skin Diseases in Women: Part 2. Pregnancy-Related Dermatoses

, University of Singapore in Singapore, National Skin Centre in Singapore

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In This Article

Abstract and Introduction

Abstract

This report identifies 4 pregnancy-induced dermatoses: (1) pemphigoid gestationis, (2) polymorphic eruption of pregnancy, (3) prurigo of pregnancy, and (4) pruritic folliculitis of pregnancy. According to 1 study of 3192 pregnancies, 0.06% of the women had pemphigoid gestationis (PG), 0.5% had polymorphic eruption of pregnancy (PEP), 0.2% had prurigo of pregnancy (PP), and 0.03% had pruritic folliculitis of pregnancy (PFP). Some reports have suggested an increased risk of fetal morbidity and mortality, as well as an increased risk of premature births, among women with PG. The incidence of fetal morbidity and mortality for the other dermatoses of pregnancy appears to be similar to that in normal pregnancies. Among the drugs used in dermatology, isotretinoin and antineoplastic agents, such as methotrexate, are 2 types that present high risk during pregnancy. Antipruritic medications, such as trimeprazine and doxepin, and some nonsteroidal anti-inflammatory agents, such as indomethacin, also should be avoided during pregnancy and lactation. Analgesics, including acetaminophen, are associated with minimal risk to the fetus or infant. Use of topical corticosteroids is associated with a low risk during pregnancy. Fortunately, many dermatologic disorders allow deferral of treatment or alternate therapeutic methods during pregnancy.

Introduction

Many skin diseases occur more often or manifest differently in women than in men. For this reason, medical practitioners should be particularly aware of the clinical presentations and treatments of dermatoses in women--both during the perimenstrual period and during pregnancy. [See also Clinician's Photo Guide To Recognizing and Treating Skin Diseases in Women: Part 1. Perimenstrual Dermatoses, which discusses skin diseases that may be exacerbated perimenstrually.] This article reviews the clinical manifestations and treatment of the pregnancy-related dermatoses.

Several skin disorders are aggravated during pregnancy, while many others are induced by pregnancy; the latter represent the specific dermatoses of pregnancy. During pregnancy, cutaneous changes, including increased pigmentation and vascularity, occur as a result of physiologic alterations resulting from hormonal changes. Many pregnancy-induced conditions are reversed postpartum.

The inflammatory dermatoses specific to pregnancy have been reported under a variety of confusing names. Some have been characterized, and their clinical features, prognosis, and effect on outcome of pregnancy are well understood. The etiology of the following dermatoses of pregnancy is generally unknown, but is probably related to hormonal changes and reaction to the product of conception. Four pregnancy-induced dermatoses have been identified: (1) pemphigoid gestationis (PG), (2) polymorphic eruption of pregnancy (PEP), (3) prurigo of pregnancy (PP), and (4) pruritic folliculitis of pregnancy (PFP).

In a recent report of 3192 pregnancies, 0.06% had PG, 0.5% had PEP, 0.2% had PP, and 0.03% had PFP.[1]

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