Rashes of pregnancy: Difference between revisions
No edit summary |
No edit summary |
||
| Line 11: | Line 11: | ||
**Hyperpigmented Linea Alba | **Hyperpigmented Linea Alba | ||
**Striae gravidarum (stretch marks) | **Striae gravidarum (stretch marks) | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 57: | Line 52: | ||
*Risk: fetal morbidity | *Risk: fetal morbidity | ||
*No recent exposure to meds distinguishes it from [[Acute generalized exanthematous pustulosis|AGEP]] | *No recent exposure to meds distinguishes it from [[Acute generalized exanthematous pustulosis|AGEP]] | ||
==Evaluation== | |||
===Workup=== | |||
If concern for [[#Pemphigoid gestationis|Pemphigoid gestationis]], [[#Intrahepatic cholestasis of pregnancy|ICP]], or [[#Pustular Psoriasis of Pregnancy|Pustular psoriasis]] based on exam: | |||
*CBC | |||
*Electrolytes | |||
*LFTs | |||
==Management== | |||
==Disposition== | |||
==See Also== | ==See Also== | ||
| Line 64: | Line 70: | ||
==External Links== | ==External Links== | ||
https://www.uptodate.com/contents/dermatoses-of-pregnancy | https://www.uptodate.com/contents/dermatoses-of-pregnancy | ||
==References== | ==References== | ||
<references/> | <references/> | ||
Revision as of 13:26, 30 March 2017
Background
- First rule out life-threatening causes such as SJS or TEN
- Multiple pruritic rashes associated with pregnancy including:
- Atopic eruption of pregnancy
- Intrahepatic cholestasis of pregnancy
- Pemphigoid gestationis
- Pruritic urticarial papules and plaques of pregnancy (PUPPP)
- Pustular psoriasis of pregnancy (previously Impetigo herpetiformis)
- Non-pathologic skin changes in pregnancy:
- Melasma (facial rash)
- Hyperpigmented Linea Alba
- Striae gravidarum (stretch marks)
Differential Diagnosis
Atopic eruption of pregnancy
- Onset usually 1st/2nd trimester
- Types:
- Treatment: emolients and topical corticosteroids
- No known risk to fetus
Intrahepatic cholestasis of pregnancy
- Onset in 2nd/3rd trimesters
- LFT abnormalities
- Rash non-specific but often pruritis of hands/feet
- Pruritis distinguishes it from HELLP syndrome
- Treatment: consider starting ursodiol in consultation with OB/GYN
- Risk to fetus: prematurity, neonatal respiratory distress
Pruritic urticarial papules and plaques of pregnancy (PUPPP)
- Most common pregnancy-specific dermatosis
- Onset in last weeks of pregnancy
- Intense pruritis, often associated with striae
- Rash usually begins on abdomen
- Treat with mid- to high-potency topical steroids (e.g. Betamethasone or Triamcinolone)
- No associated risk to fetus
- Only occurs in 1st pregnancy
- Also called Polymorphic Eruption of Pregnancy (PEP)
Pemphigoid gestationis
- Autoimmune disorder
- Onset: 2nd/3rd trimester
- Rash: pruritic papules and vesicles with bullae, usually starts periumbilical
- Treatment: High-potenecy topical steroids +/- prednisone (0.5mg/kg/day) and oral antihistamines
- Risk: fetal prematurity
Pustular Psoriasis of Pregnancy
- Onset: 3rd trimester
- Rash: painful pustules, usually start on thighs
- Management: admit to OB/GYN for fetal monitoring
- Risk: fetal morbidity
- No recent exposure to meds distinguishes it from AGEP
Evaluation
Workup
If concern for Pemphigoid gestationis, ICP, or Pustular psoriasis based on exam:
- CBC
- Electrolytes
- LFTs
Management
Disposition
See Also
External Links
https://www.uptodate.com/contents/dermatoses-of-pregnancy
References
- ↑ Tunzi, Marc et al, "Common Skin Conditions During Pregnancy" Am Fam Physician. 2007 Jan 15;75(2):211-218. http://www.aafp.org/afp/2007/0115/p211.html