Rashes of pregnancy: Difference between revisions
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*Treatment: emolients and topical corticosteroids | *Treatment: emolients and topical corticosteroids | ||
*No known risk to fetus | *No known risk to fetus | ||
===Intrahepatic cholestasis of pregnancy=== | ===Intrahepatic cholestasis of pregnancy=== | ||
*Onset in 2nd/3rd trimesters | *Onset in 2nd/3rd trimesters | ||
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*Treatment: consider starting ursodiol in consultation with OB/GYN | *Treatment: consider starting ursodiol in consultation with OB/GYN | ||
*Risk to fetus: prematurity, neonatal respiratory distress | *Risk to fetus: prematurity, neonatal respiratory distress | ||
===Pruritic urticarial papules and plaques of pregnancy (PUPPP)=== | ===Pruritic urticarial papules and plaques of pregnancy (PUPPP)=== | ||
*Most common pregnancy-specific dermatosis | *Most common pregnancy-specific dermatosis | ||
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*Only occurs in 1st pregnancy | *Only occurs in 1st pregnancy | ||
*Also called Polymorphic Eruption of Pregnancy (PEP) | *Also called Polymorphic Eruption of Pregnancy (PEP) | ||
===Pemphigoid gestationis=== | ===Pemphigoid gestationis=== | ||
*Autoimmune disorder | *Autoimmune disorder | ||
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*Treatment: High-potenecy [[Topical steroids|topical steroids]] +/- prednisone (0.5mg/kg/day) and oral antihistamines | *Treatment: High-potenecy [[Topical steroids|topical steroids]] +/- prednisone (0.5mg/kg/day) and oral antihistamines | ||
*Risk: fetal prematurity | *Risk: fetal prematurity | ||
===Pustular Psoriasis of Pregnancy=== | ===Pustular Psoriasis of Pregnancy=== | ||
*Onset: 3rd trimester | *Onset: 3rd trimester | ||
Revision as of 13:27, 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