Dermatoses of pregnancy

There are a number of specific dermatological conditions which arise in pregnancy only. The most common is termed polymorphic eruption of pregnancy affecting approximately 0.5% of pregnancies. This maculo-papular rash presents on the abdomen and thighs with umbilical sparing. It causes irritation and can be treated with steroid cream if localized, or systemic steroids. Skin biopsy is sometimes necessary in pregnancy, typically when there is a relatively early presentation and significant maternal symptoms. Polymorphic eruption tends to arise in the late third trimester and not to recur in subsequent pregnancies.

Pemphigoid gestationis in contrast is much rarer (1/60,000 incidence) and commences around the umbilicus. It commences as pruritic papules and plaques which develop into vesicles and bullae after a few weeks. It is thought to be immunological in origin and is associated with other autoimmune disorders. Severe cases should be treated with systemic steroids. This rash can be slow to resolve after delivery and has a high risk of recurrence in subsequent pregnancies, often at earlier gestations. This condition appears to be associated with some fetal risk and IUGR, and therefore fetal surveillance must be instituted.

Prurigo of pregnancy is another papular eruption affecting extensor surfaces and the abdomen. It may be associated with atopy and can be treated with antihistamines and topical steroids. There are other dermatoses which can arise specifically in pregnancy. Dermatological opinion and biopsy tend to be reserved for those that are particularly disabling, or have failed to respond to topical steroids.

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