Skip to Main Content

CHAPTER 65: Dermatological Disorders

PREGNANCY-SPECIFIC DERMATOSES

Four dermatoses considered unique to pregnancy are pemphigoid gestationis (PG), pruritic urticarial papules and plaques of pregnancy (PUPPP), atopic eruption of pregnancy (AEP), and intrahepatic cholestasis of pregnancy. Descriptions of these are given in Table 65-1. Their gross appearance can be similar to each other or to other skin disorders, and pruritus is a common feature. Of these four, adverse fetal outcomes are linked only with PG and intrahepatic cholestasis. The latter is discussed in detail in Chapter 58 (p. 1032). It generally lacks primary skin lesions, but pruritus is usually associated with abnormally elevated serum bile acid levels and mildly increased hepatic transaminase levels.

TABLE 65-1Pregnancy-specific Dermatoses
View Table||Download (.pdf)
TABLE 65-1Pregnancy-specific Dermatoses
Disorder Frequency Characteristic Lesion Adverse Pregnancy Effects Treatment
PUPPP Common Erythematous pruritic papules or plaques; patchy or generalized on abdomen, thighs, buttocks, especially within striae, but with umbilical sparing None Oral antipruritics, emollients, topical corticosteroids, and if severe, oral steroids
AEP None
Eczema in 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
Cholestasis of pregnancy Common No primary lesions, secondary excoriations from scratching Increased perinatal morbidity Oral antipruritics, cholestyramine, ursodeoxycholic acid

AEP = atopic eruptions of pregnancy; PUPPP = pruritic urticarial papules and plaques of pregnancy.

Pemphigoid Gestationis

In this rare autoimmune bullous disease, pruritic papules and urticarial plaques initially form. Vesicles or bullae usually follow after 1 to 2 weeks. Lesions frequently involve umbilicus and other skin surfaces but typically spare mucous membranes, scalp, and face (Fig. 65-1).

FIGURE 65-1

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

Two photos, A and B, show lesions in Pemphigoid gestationis.
View Full Size||Download Slide (.ppt)

Previously termed herpes gestationis, PG is not related to the herpesvirus. Instead, maternal immunoglobulin G (IgG) antibodies target collagen XVII found in the basement membrane of skin and amnionic epithelium (Kelly, 1988; Sadik, 2016). Collagen XVII is also termed bullous pemphigoid 180 (BP180). Autoantibody binding to BP180 activates complement to promote eosinophil chemotaxis to the antigen-antibody complexes. Eosinophilic degranulation damages the dermal–epidermal junction and leads to blistering.

Pregnancy

In most cases, PG develops during a first pregnancy. Most subsequent pregnancies also are affected, usually earlier and more severely (Tani, 2015). Additionally, other autoimmune diseases, especially Graves disease, are frequent in affected women (Jenkins, 1999; Shornick, 1992).

PG usually begins during the ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

This site uses cookies to provide, maintain and improve your experience. MH Privacy Center Close