- Normal skin changes associated with pregnancy are darkening of linea alba (linea nigra), melasma (see Section 13), striae distensae (Fig. 15-1).
- Pruritus occurring in pregnancy may be due to a flare of preexisting dermatosis or a pregnancy-specific dermatosis.
- Pregnancy-specific dermatoses associated with fetal risk are cholestasis in pregnancy, pustular psoriasis of pregnancy (impetigo herpetiformis), and pemphigoid gestationis.
- Pregnancy-specific dermatoses not associated with fetal risk are polymorphic eruption of pregnancy and prurigo gestationis.
Striae distensae in a pregnant woman (36 weeks of gestation)
Cholestasis of Pregnancy (CP)
ICD-9 : 646.7 • ICD-10 : K83.1
- Occurs in the third trimester.
- Leading symptoms: pruritus, either localized (palms) or generalized. Most severe during the night.
- Cutaneous lesions invariably absent, but excoriations in severe cases.
- Elevation of serum bile acids.
- Fetal risks include prematurity, intrapartal distress, and fetal death.
- Treatment: ursodeoxycholic acid, plasmapheresis.
Pustular Psoriasis in Pregnancy
ICD-9 : 696.7 • ICD-10 : L40.1
- Previously called impetigo herpetiformis.
- Clinically and histopathologically indistinguishable from pustular psoriasis of von Zumbusch
- Burning, smarting, not itching.
- May have hypocalcemia and decreased vitamin D levels.
- See “Pustular Psoriasis,” Section 3.
ICD-9 : 646.8 • ICD-10 : O26.4
Pemphigoid gestationis (PG) is a pruritic polymorphic inflammatory dermatosis of pregnancy and the postpartum period. It is an autoimmune process with circulating complement-fixing IgG antibodies in the serum. The condition is described in Section 6.
Polymorphic Eruption of Pregnancy (PEP)
ICD-9 : 709.8
- PEP is a distinct pruritic eruption of pregnancy that usually begins in the third trimester, most often in primigravidae (76%).
- There is no increased risk of fetal morbidity or mortality.
- The disease is common, estimated to be 1 in 120 to 240 pregnancies.
- The etiology and pathogenesis are not understood.
- Average time of onset is 36 weeks of gestation, usually 1–2 weeks before delivery. However, symptoms and signs can start in the postpartum period.
- Pruritus develops on the abdomen, often in the striae distensae, and is severe enough to disrupt sleep. Skin lesions consist of erythematous papules, 1–3 mm, quickly coalescing into urticarial plaques (Fig. 15-2) with polycyclic shape and arrangement; blanched halos around the periphery of lesions. Tiny vesicles, 2 mm, may occur in the plaques, but bullae are absent. Target lesions are observed in 19%. Although pruritus is the chief symptom, excoriations are infrequent. 50% of the women affected have papules and plaques in the striae distensae; the abdomen, buttocks, thighs (Fig. 15-2), upper inner arms, and lower back may also be affected.
- The face, breasts, palms, and soles are rarely involved. The periumbilical area is usually spared. There are no mucous ...