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CHAPTER 62: Dermatological Disorders

Herpes Gestationis—This disease, more frequently known as dermatitis herpetiformis is an inflammatory superficially seated multiform herpetiform eruption, which is characterized by erythematous, vesicular, pustular, and bullous lesions.

—J. Whitridge Williams (1903)

PREGNANCY-SPECIFIC DERMATOSES

Four dermatoses considered unique to pregnancy include intrahepatic cholestasis of pregnancy, pruritic urticarial papules and plaques of pregnancy (PUPPP), atopic eruption of pregnancy (AEP), and pemphigoid gestationis (PG). Descriptions of these are given in Table 62-1. As a group, these are diagnosed in up to 5 percent of pregnancies (Chander, 2011). Their gross appearance may be similar to each other or to other skin disorders, and pruritus is a common feature of all four. Only intrahepatic cholestasis and pemphigoid gestationis have been linked with adverse fetal outcomes.

TABLE 62-1Pregnancy-specific Dermatoses
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TABLE 62-1 Pregnancy-specific Dermatoses
Disorder Frequency Characteristic Lesion Adverse Pregnancy Effects Treatment
Cholestasis of pregnancy Common No primary lesions, secondary excoriations from scratching Increased perinatal morbidity Antipruritics, cholestyramine, ursodeoxycholic acid
Pruritic urticarial papules and plaques of pregnancy (PUPPP) Common Erythematous pruritic papules or plaques; patchy or generalized on abdomen, thighs, buttocks, especially within striae, but with umbilical sparing None
Atopic eruptions of pregnancy (AEP) None Antipruritics, emollients, topical corticosteroids, oral steroids if severe
Eczema of pregnancy Common Dry, red scaly patches on extremity flexures, neck, face
Prurigo of pregnancy Common 1–5 mm pruritic red papules on extensor surfaces, trunk
Pruritic folliculitis of pregnancy Rare Small red papules, sterile pustules on trunk
Pemphigoid gestationis Rare Erythematous pruritic papules, plaques, vesicles, and bullae; abdomen often with umbilical involvement, extremities Preterm birth, fetal-growth restriction, transient neonatal lesions

Intrahepatic Cholestasis of Pregnancy

Previously termed pruritus gravidarum, this condition is found in 0.5 percent of pregnancies (Wikström Shemer, 2013). In contrast to the other pregnancy-specific dermatoses, intrahepatic cholestasis of pregnancy generally has no primary skin lesions. Rarely, a rash precedes pruritus, which is usually associated with abnormally elevated serum bile acid levels and mildly increased hepatic aminotransferase levels (Chao, 2011). Adverse fetal effects have been linked to this condition, and it is discussed in detail in Chapter 55 (Intrahepatic Cholestasis of Pregnancy).

Pemphigoid Gestationis

This rare autoimmune bullous disease is notable for its maternal and fetal effects. Initially, pruritic papules and urticarial plaques form and are then followed in most cases after 1 to 2 weeks by vesicles or bullae. Lesions are frequently distributed periumbilically, often develop on other skin surfaces, but spare mucous membranes, scalp, and face (Fig. 62-1).

FIGURE 62-1

Pemphigoid gestationis. A. Abdominal plaques classically involve the umbilicus. B. Blistered lesions on the wrist and forearm. (Used with permission from Dr. Kara Ehlers.)

Two photos, A and B, show lesions in Pemphigoid gestationis.
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Previously termed herpes gestationis, pemphigoid gestationis is not related ...

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