Rashes of pregnancy: Difference between revisions
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==Background== | ==Background== | ||
*First rule out life-threatening causes such as [[Stevens-Johnson syndrome and toxic epidermal necrolysis|SJS or TEN]] | *First rule out life-threatening causes of [[rash]] such as [[Stevens-Johnson syndrome and toxic epidermal necrolysis|SJS or TEN]] | ||
*Multiple pruritic rashes associated with [[Pregnancy (main)|pregnancy]] including: | *Multiple pruritic rashes associated with [[Pregnancy (main)|pregnancy]] including: | ||
**Atopic eruption of pregnancy | **Atopic eruption of pregnancy | ||
**Intrahepatic cholestasis of pregnancy | **Intrahepatic [[cholestasis of pregnancy]] | ||
**Pemphigoid gestationis | **Pemphigoid gestationis | ||
**Pruritic urticarial papules and plaques of pregnancy (PUPPP) | **Pruritic urticarial papules and plaques of pregnancy (PUPPP) | ||
**Pustular psoriasis of pregnancy (previously Impetigo herpetiformis) | **Pustular [[psoriasis]] of pregnancy (previously Impetigo herpetiformis) | ||
*Non-pathologic skin changes in pregnancy: | *Non-pathologic skin changes in pregnancy: | ||
**Melasma (facial rash) | **Melasma (facial rash) | ||
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*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 | ||
*LFT abnormalities | *[[LFTs|LFT]] abnormalities | ||
*Rash non-specific but often pruritis of hands/feet | *Rash non-specific but often pruritis of hands/feet | ||
* | *[[Pruritus]] distinguishes it from [[HELLP syndrome]] | ||
*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 | ||
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*Most common pregnancy-specific dermatosis | *Most common pregnancy-specific dermatosis | ||
*Onset in last weeks of pregnancy | *Onset in last weeks of pregnancy | ||
*Intense | *Intense pruritus, often associated with striae | ||
*Rash usually begins on abdomen | *Rash usually begins on abdomen | ||
*Treat with mid- to high-potency [[Topical steroids|topical steroids]] (e.g. Betamethasone or Triamcinolone) | *Treat with mid- to high-potency [[Topical steroids|topical steroids]] (e.g. Betamethasone or Triamcinolone) | ||
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*Autoimmune disorder | *Autoimmune disorder | ||
*Onset: 2nd/3rd trimester | *Onset: 2nd/3rd trimester | ||
*Rash: pruritic papules and vesicles with bullae, usually starts periumbilical | *[[Rash]]: pruritic papules and vesicles with bullae, usually starts periumbilical | ||
*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 | ||
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===Pustular Psoriasis of Pregnancy=== | ===Pustular Psoriasis of Pregnancy=== | ||
*Onset: 3rd trimester | *Onset: 3rd trimester | ||
*Rash: painful pustules, usually start on thighs | *[[Rash]]: painful pustules, usually start on thighs | ||
*Management: admit to OB/GYN for fetal monitoring | *Management: admit to OB/GYN for fetal monitoring | ||
*Risk: fetal morbidity | *Risk: fetal morbidity | ||
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*CBC | *CBC | ||
*Electrolytes | *Electrolytes | ||
*LFTs | *[[LFTs]] | ||
==Management== | ==Management== | ||
*Based on suspected condition | |||
==Disposition== | ==Disposition== | ||
Revision as of 01:33, 28 September 2019
Background
- First rule out life-threatening causes of rash 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
- Pruritus 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 pruritus, 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
- Based on suspected condition
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