Pregnancy-Specific Skin Disorders

Skyler White, BS; Rebecca Philips, MD; Megan Moody Neill, MD; Erica Kelly, MD

Disclosures

Skin Therapy Letter. 2014;19(5) 

In This Article

Abstract and Introduction

Abstract

The pregnancy-specific skin disorders are pruritic, inflammatory eruptions. The current classification by Ambros-Rudolph et al. includes four entities: pemphigoid gestationis (PG), polymorphic eruption of pregnancy (PEP), atopic eruption of pregnancy (AEP), and intrahepatic cholestasis of pregnancy (ICP). Although these disorders are all characterized by intense pruritus during pregnancy, they can be distinguished by timing, morphology, histopathology, treatment and potential for fetal complications. Diagnosis is made by clinical presentation, histology, and immunofluorescence. PEP and AEP typically resolve without sequelae; however, PG may lead to prematurity and low birth weight, and ICP is associated with an increased risk of prematurity, fetal distress, and intrauterine fetal demise. The potential for serious fetal complications necessitates a thorough evaluation of pregnancy-related pruritus. This article will discuss the skin disorders specific to pregnancy, with a focus on clinical presentation, potential for fetal complications, pathogenesis, diagnosis, and treatment.

Introduction

While pregnancy may result in a number of skin changes, there are pruritic eruptions that occur specific to pregnancy and the postpartum period.[1–3] In 1983, Holmes and Black proposed a classification of pregnancy-specific skin disorders, which included pemphigoid gestationis, polymorphic eruption of pregnancy, prurigo of pregnancy, and pruritic folliculitis of pregnancy.[4] In 1998, Shornick proposed the addition of intrahepatic cholestasis of pregnancy.[5] The current classification was proposed by Ambros-Rudolph et al. in 2006 on the basis of a large retrospective study of 505 patients, and includes four entities: pemphigoid gestastionis, polymorphic eruption of pregnancy, atopic eruption of pregnancy (encompassing prurigo of pregnancy and pruritic folliculitis of pregnancy), and intrahepatic cholestasis of pregnancy.[2]

A major etiology of skin changes in pregnancy involves alterations in the maternal immune system. To prevent fetal rejection, an imbalance is created between cellular and humoral immunity.[1–3] T helper type 2 (Th2) cytokine production is favored over Th1, enhancing humoral immunity and stunting cell-mediated immunity. The changes in maternal hormones are also believed to have an effect, as many skin disorders develop during the third trimester.[3]

This article will discuss the skin disorders specific to pregnancy, with a focus on clinical presentation, potential for fetal complications, pathogenesis, diagnosis, and treatment.

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