22
Pregnancy Dermatoses
There are several dermatoses that occur during pregnancy or immediately postpartum, in particular polymorphic eruption of pregnancy, pemphigoid gestationis, and atopic eruption of pregnancy. Pruritus due to intrahepatic cholestasis of pregnancy leads to nonspecific skin lesions, including excoriations due to scratching. Impetigo herpetiformis simply represents pustular psoriasis occurring during pregnancy, and this may be related to the relative hypocalcemia of pregnancy. Lastly, there are physiologic changes that occur during pregnancy.
Polymorphic Eruption of Pregnancy (PEP; Pruritic Urticarial Papules and Plaques of Pregnancy [PUPPP])
• Pruritic edematous papules and plaques, whose color varies from pink to red-brown depending on skin phototype, that often involve the abdominal striae but spare the umbilicus (Fig. 22.1); polymorphic presentation includes patches of erythema, targetoid lesions, tiny vesicles, and eczematous plaques (Fig. 22.2).
Fig. 22.1 Polymorphic eruption of pregnancy. The edematous urticarial lesions favor the striae (A, C) and the upper thighs (B, D) and spare the umbilicus. Note the pink color in a woman with skin phototype II versus the red-brown color in a more darkly pigmented patient.
• Rx: topical CS and oral antihistamines usually suffice (see Appendix); occasionally, severe cases require oral CS (prednisolone preferred during pregnancy because of significant inactivation by placenta, leading to a mother : fetus ratio of 10 : 1).
