Specific dermatoses of pregnancy: New classification and differential diagnosis

Introduction The specific dermatoses of pregnancy represent heterogeneous group of pruritic skin disorders that occur exclusively in pregnancy. Specific Dermatoses of pregnancy The updated classification proposed subdividing specific dermatoses of pregnancy into four main categories: 1. atopic eruption of pregnancy; 2. polymorphic eruption of pregnancy; 3. pemphigoid gestationis; 4. intrahepatic cholestasis of pregnancy. Severe pruritius, which is the main symptom in all 4 entities, can impair maternal quality of life. Significant maternal risks are not associated with specific dermatoses of pregnancy; however, pemphigoid gestationis and intrahepatic cholestasis of pregnancy are associated with fetal risks. Conclusion Pathognomonic laboratory tests are not available, except direct immunofluorescence which is diagnostic of pemphigoid gestationis and elevated serum level of bile acids of intrahepatic cholestasis of pregnancy. Characteristic clinical features provide discrimination between polymorphic eruption of pregnancy and atopic eruption of pregnancy.

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Dermatological Diseases Associated with Pregnancy: Pemphigoid Gestationis, Polymorphic Eruption of Pregnancy, Intrahepatic Cholestasis of Pregnancy, and Atopic Eruption of Pregnancy

Dermatology Research and Practice ◽

10.1155/2015/979635 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Christine Sävervall ◽

Freja Lærke Sand ◽

Simon Francis Thomsen

Keyword(s):

Intrahepatic Cholestasis ◽

Clinical Importance ◽

Intrahepatic Cholestasis Of Pregnancy ◽

Pemphigoid Gestationis ◽

Polymorphic Eruption Of Pregnancy ◽

Atopic Eruption Of Pregnancy ◽

Considerable Morbidity ◽

Dermatoses Of Pregnancy ◽

Cholestasis Of Pregnancy ◽

Pregnant Mothers

Dermatoses unique to pregnancy are important to recognize for the clinician as they carry considerable morbidity for pregnant mothers and in some instances constitute a risk to the fetus. These diseases include pemphigoid gestationis, polymorphic eruption of pregnancy, intrahepatic cholestasis of pregnancy, and atopic eruption of pregnancy. This review discusses the pathogenesis, clinical importance, and management of the dermatoses of pregnancy.

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Dermatoses Específicas da Gravidez

Acta Médica Portuguesa ◽

10.20344/amp.2006 ◽

2013 ◽

Vol 26 (5) ◽

pp. 593

Author(s):

Vera Teixeira ◽

Inês Coutinho ◽

Rita Gameiro ◽

Ricardo Vieira ◽

Margarida Gonçalo

Keyword(s):

Intrahepatic Cholestasis ◽

Skin Diseases ◽

Intrahepatic Cholestasis Of Pregnancy ◽

Vascular Changes ◽

Safe Treatment ◽

Timely Diagnosis ◽

Polymorphic Eruption Of Pregnancy ◽

Atopic Eruption Of Pregnancy ◽

Cholestasis Of Pregnancy

During pregnancy immunological, metabolic, hormonal and vascular changes occur, and can cause specific skin diseases. The specificdermatoses of pregnancy have undergone numerous changes in nomenclature and classification, partly due to advances in the knowledge of the pathogenesis of these skin diseases. Currently the following diseases are considered specific dermatoses of pregnancy:pemphigoid gestations, polymorphic eruption of pregnancy, intrahepatic cholestasis of pregnancy and atopic eruption of pregnancy. Timely diagnosis and specific and safe treatment are essential to prevent complications which, although rare, may be associated with significant maternal-fetal comorbidity.

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Dermatoses of pregnancy. A prospective study from Benghazi, Libya

Journal of Dermatology & Cosmetology ◽

10.15406/jdc.2019.3.00134 ◽

2019 ◽

Vol 3 (6) ◽

pp. 166

Author(s):

Safa Suleman Elfaituri

Keyword(s):

Prospective Study ◽

Intrahepatic Cholestasis ◽

Skin Diseases ◽

Fetal Mortality ◽

Intrahepatic Cholestasis Of Pregnancy ◽

Pemphigoid Gestationis ◽

Fetal Risk ◽

Atopic Eruption Of Pregnancy ◽

A Prospective Study ◽

Cholestasis Of Pregnancy

Introduction: Cutaneous findings in pregnancy can be physiologic, coincidental, alterations in pre-existing skin diseases or pregnancy specific. The Pregnancy dermatoses can impact the health of the pregnant woman and the fetus Objectives: Our objective was to determine the spectrum of skin disease associated with pregnancy and to identify the various types of pregnancy specific dermatoses and their fetal risk. Materials & methods: A prospective study was performed at dermatology out-patient department of Jumhoria hospital and Ibn Sina polyclinic, Benghazi-Libya over a period of 2 years. A total of 200 pregnant women presented with dermatological complaint were included. History, skin examination, and relevant investigations were performed. The patients with pregnancy specific dermatoses were followed up till delivery and the pregnancy outcome was recorded. The results were analyzed using SPSS. Results: Mean age was 32 years, 62% was multigravidae and 54% of pregnancy dermatoses occurred during third trimester. The highest number of cases presented with coincidental or preexisting diseases (71%); infections (34%), pre-existing skin diseases included eczema (13%), acne vulgaris (4%) and psoriasis (3%) Hyperpigmentation and strieagravidarum represented the main physiological changes (17%). Specific pregnancy dermatoses were present in 12%, these were intrahepatic cholestasis of pregnancy (4%), atopic eruption of pregnancy (3%), pemphigoid gestationis (3%) and polymorphic eruption of pregnancy (2%). Fetal complications including fetal mortality were reported with pemphigoid gestationis (30%) and intrahepatic cholestasis of pregnancy (25%). Conclusions: This study provides important data on the spectrum of pregnancy dermatoses in Libyan patients. Most of the reported pregnancy dermatoses were benign with no adverse effect on the fetus. Pemphigoid gestationis and intrahepatic cholestasis of pregnancy can be a source of significant fetal risk. To the best of our knowledge this is the first study carried out on pregnancy dermatoses in Benghazi, Libya.

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Dermatoses Of Pregnancy: A Retrospective Cohort Study In Spain

10.21203/rs.2.18995/v1 ◽

2019 ◽

Author(s):

M. Gomes Ferreira ◽

D. Bancalari Diaz ◽

Á. De Dios Velázquez ◽

J. Cañueto

Keyword(s):

Mediterranean Population ◽

Pemphigoid Gestationis ◽

Skin Changes ◽

Inflammatory Dermatoses ◽

Polymorphic Eruption Of Pregnancy ◽

Multiple Gestations ◽

Nulliparous Women ◽

Atopic Eruption Of Pregnancy ◽

Dermatologic Disease ◽

Dermatoses Of Pregnancy

Abstract Background: Dermatoses of pregnancy (DP) is a heterogeneous group of pruritic inflammatory dermatoses that occur exclusively during pregnancy and/or puerperium. The objective of this study was to assess the specific DP and non-specific dermatoses in a Mediterranean population living in Spain. Methods: This five-year retrospective study included 79 pregnant women with dermatologic disease from a total of 10533 pregnancies. Obstetric and clinical variables were assessed. Physiological skin changes of pregnancy were excluded. Those dermatoses that may also be observed beyond pregnancy and puerperium were also excluded. Results: The mean age was 32 years. The most common DP were: Polymorphic eruption of pregnancy (PEP) – 36%, Atopic eruption of pregnancy (AEP) – 26%, Intrahepatic cholestasis of pregnancy (ICP) – 8% and Pemphigoid gestationis (PG) – 6%. The other 24% presented non-specific dermatoses. Only in one case of PG the newborn showed comorbidity. Discussion: Multiple gestations were observed in 10,3% of PEP, in association with a rapid abdominal distention. In AEP, there was a predominance of nulliparous women in the second trimester of pregnancy, an atopic dermatitis background and female newborns. In PG, there was a majority of nulliparous in the second and third trimesters. PG was the only dermatoses associated to comorbidity of the newborn. In ICP, all patients had pruritus in the palms along with excoriations, with predominance of nulliparous and multiple gestations.

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Fetal complications due to intrahepatic cholestasis of pregnancy

Journal of Perinatal Medicine ◽

10.1515/jpm-2014-0089 ◽

2015 ◽

Vol 43 (2) ◽

Cited By ~ 17

Author(s):

Patrik Šimják ◽

Antonín Pařízek ◽

Libor Vítek ◽

Andrej Černý ◽

Karolína Adamcová ◽

...

Keyword(s):

Intrahepatic Cholestasis ◽

Current Knowledge ◽

Elevated Serum ◽

Liver Function Tests ◽

Liver Disorder ◽

Intrauterine Fetal Death ◽

Intrahepatic Cholestasis Of Pregnancy ◽

Management Options ◽

Fetal Complications ◽

Cholestasis Of Pregnancy

AbstractIntrahepatic cholestasis of pregnancy (ICP) is the most common liver disorder of pregnancy. Diagnosis is based on the clinical picture, particularly the presence of pruritus with a deterioration of liver function tests, and typically elevated serum levels of total bile acids. ICP manifests in the second half of pregnancy, predominantly during the third trimester. Symptoms of the disease resolve spontaneously after delivery. Etiology is still not fully understood. Genetic defects in specific transport proteins, elevated levels of sex hormones, and various environmental factors are thought to play a role in the development of this disorder. Although practically benign for the pregnant woman, ICP represents a serious threat to the fetus. It increases the risk of preterm delivery, meconium excretion into the amniotic fluid, respiratory distress syndrome, and sudden intrauterine fetal death. Identifying fetuses at risk of ICP complications remains challenging. The ideal obstetrical management of ICP needs to be definitively determined. The aim of this review is to summarize the current knowledge on fetal complications of ICP and describe management options for their prevention.

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The Role of Melatonin, IL-8 and IL-10 in Intrahepatic Cholestasis of Pregnancy

Zeitschrift für Geburtshilfe und Neonatologie ◽

10.1055/a-1233-9084 ◽

2020 ◽

Author(s):

Samettin Çelik ◽

Huri Guve ◽

Canan Çalışkan ◽

Sebahattin Çelik

Keyword(s):

Intrahepatic Cholestasis ◽

Inflammatory Cytokine ◽

Elevated Serum ◽

Interleukin 10 ◽

Interleukin 8 ◽

Controlled Study ◽

Control Group ◽

Intrahepatic Cholestasis Of Pregnancy ◽

Cholestasis Of Pregnancy

Abstract Introduction Intrahepatic cholestasis of pregnancy is a pregnancy-specific liver disease that usually emerges during the third trimester of pregnancy. It is characterized by itching and elevated serum total bile acid levels, and it may lead to severe fetal complications. This study aimed to investigate the role of interleukin-8, a pro-inflammatory cytokine; interleukin-10, an anti-inflammatory cytokine; and melatonin in intrahepatic cholestasis of pregnancy. Materials and Methods This prospective, case-controlled study was conducted with 51 women with intrahepatic cholestasis of pregnancy (40 mild and 11 severe cases) and 43 healthy pregnant women. Serum interleukin-8, interleukin-10, and melatonin levels were evaluated. Results Melatonin and interleukin -10 were significantly lower in subjects with intrahepatic cholestasis of pregnancy (p=0.001; p=0.001, respectively p<0.05). Interleukin-8 levels were found to be significantly higher in the cholestasis group than control group (p=0.001, p<0.05). Conclusions Because interleukin-8, interleukin-10, and melatonin were found to be significantly correlated with intrahepatic cholestasis of pregnancy, we believe this finding could shed light on the etiology of the disease.

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Molecular pathogenesis of intrahepatic cholestasis of pregnancy

Expert Reviews in Molecular Medicine ◽

10.1017/s1462399408000628 ◽

2008 ◽

Vol 10 ◽

Cited By ~ 55

Author(s):

Marco Arrese ◽

Rocio I.R. Macias ◽

Oscar Briz ◽

Maria J. Perez ◽

Jose J.G. Marin

Keyword(s):

Intrahepatic Cholestasis ◽

Molecular Level ◽

Current Knowledge ◽

Elevated Serum ◽

Transport Proteins ◽

Serum Bile Acid ◽

Intrahepatic Cholestasis Of Pregnancy ◽

Secretory Function ◽

Third Trimester ◽

Cholestasis Of Pregnancy

Intrahepatic cholestasis of pregnancy (ICP) occurs mainly in the third trimester and is characterised by pruritus and elevated serum bile acid levels. ICP is associated with an increased perinatal risk and higher rates of foetal morbidity and mortality. Although the pathogenesis of this disease is unknown, a genetic hypersensitivity to female hormones (oestrogen and/or progesterone) or their metabolites is thought to impair bile secretory function. Recent data suggest that mutations or polymorphisms of genes expressing hepatobiliary transport proteins or their nuclear regulators may contribute to the development and/or severity of ICP. Unidentified environmental factors may also influence pathogenesis of the disease. This review summarises current knowledge on the potential mechanisms involved in ICP at the molecular level.

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Intrahepatic Cholestasis of Pregnancy: Natural History and Current Management

Seminars in Liver Disease ◽

10.1055/s-0040-1722264 ◽

2021 ◽

Author(s):

Rebecca Roediger ◽

Jaquelyn Fleckenstein

Keyword(s):

Adverse Effects ◽

Intrahepatic Cholestasis ◽

Elevated Serum ◽

Reproductive Hormones ◽

Intrahepatic Cholestasis Of Pregnancy ◽

Current Management ◽

Immune Mediated ◽

Increased Risk ◽

Fetal Complications ◽

Cholestasis Of Pregnancy

AbstractIntrahepatic cholestasis of pregnancy (ICP) is a common disorder in the second half of pregnancy characterized by pruritus and elevated serum bile acids (BAs) with spontaneous resolution after delivery. ICP carries a risk of adverse effects on the fetus which correlates with the degree of BA elevation. ICP occurs in genetically susceptible women as the reproductive hormones increase during pregnancy. Ursodeoxycholic acid is still considered the first-line treatment for ICP though it is of unproven benefit in preventing adverse effects on the fetus. Fetal complications, such as stillbirth, increase with gestational age, so preterm delivery is generally performed in cases of severe ICP, defined as BA levels above 40 μmol/L. ICP may recur in future pregnancies and is associated with an increased risk for future hepatobiliary, immune mediated, and cardiovascular diseases. Children born of mothers with ICP have normal development but may have a risk for subsequent metabolic disease.

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Seasonal Impact in the Frequency of Intrahepatic Cholestasis of Pregnancy

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2016.87 ◽

2016 ◽

Vol 22 (1) ◽

Author(s):

Cem Yaşar Sanhal ◽

Korkut Dağlar ◽

Özgür Kara ◽

Ayşe Kırbaş ◽

Dilek Uygur ◽

...

Keyword(s):

Logistic Regression ◽

Intrahepatic Cholestasis ◽

Elevated Serum ◽

Cumulative Risk ◽

Serum Bile Acid ◽

Intrahepatic Cholestasis Of Pregnancy ◽

Chi Square ◽

Serum Aminotransferase ◽

Bile Acid Concentration ◽

Cholestasis Of Pregnancy

Objective: To evaluate the presence of any seasonal variation in the frequency of intrahepatic cholestasis of pregnancy (ICP). Study Design: A total of 126 cases with ICP were compared with a cohort of 37614 pregnant women who delivered. The diagnosis ICP was performed on the basis of severe itching and the absence of dermal rash and any other hepatic disease, with the co-existence of elevated serum aminotransferase levels and/or serum bile acid concentration. For each month and season, observed and expected ICP rates were analysed and compared by using chi-square statistics. Multivariate logistic regression was performed to investigate certain parameters on cumulative risk. Results: A significantly lower frequency of ICP in winter (6/126 (4.8%), p=0.001) and a significantly higher frequency in spring (44/126 (34.9%), p=0.034) were detected. A 2.1 and 3.8-fold higher risk were found for the nulliparity and the twin pregnancy, respectively. Logistic regression analysis confirmed the significant (10-fold) decrease in the frequency of ICP in winter. The significance of spring did not persist after the adjustment. Conclusion: Main outcome of the study points at seasonality in ICP frequency. Future studies in different populations may reveal data about factors that interact with seasonality and playing roles in ICP.

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