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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Polymorphic Eruption of Pregnancy

PEP is a common dermatosis of pregnancy that is estimated to occur in 1 in 120 to 240 pregnancies.[2] Laboratory investigations have generally not revealed any hormonal abnormalities. The cause of PEP is unknown. This condition does not appear to be associated with an autoimmune disorder nor with a distinctive immunogenic profile.

The affected patients are usually primigravida with prominent striae, showing a greater increase in maternal weight gain, neonatal birth weight, and twin rate than controls.[3] Because of this observation, one hypothesis suggests that abnormal skin distention resulting in skin damage may play a role in the development of PEP.

The condition presents as pruritic papules and plaques, beginning along the striae of the abdomen (Fig. 2) and then slowly spreading to the rest of the body. The skin eruptions appear in crops during the third trimester of pregnancy and clear after puerperium.

Differential diagnoses. Differential diagnoses include chronic urticaria, eczema (endogenous and contact dermatitis), and drug-induced eruptions. Diagnosis here is clinical and--after the exclusion of other skin diseases--clearing of the condition after puerperium also can confirm the diagnosis of PEP.

Figure 2. Pruritic papules and plaques, beginning along striae of abdomen and slowly spreading to rest of body, may indicate polymorphic eruption of pregnancy. Lesions appear in crops during third trimester of pregnancy and clear after puerperium.

Treatment. Treatment of PEP is conservative. Topical steroids usually help to control the skin eruptions and the pruritus. In severe cases occurring during late pregnancy, systemic steroids and antihistamines may be used.


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