A study of dermatoses in antenatal patients attending tertiary care centre

<p><strong>Background: </strong>Pregnancy produces many cutaneous changes which can be either physiological, alteration in pre-existing skin diseases or development of dermatoses which are specific to pregnancy which occur due to the production of a number of proteins and steroid hormones by the fetoplacental unit and maternal pituitary, thyroid and adrenals. Patient’s concern may range from cosmetic appearance to potential effects on mother and fetus. Aims and objectives: Study was undertaken to observe physiological and pathological skin changes in different gravidae and trimesters of pregnancy.</p><p><strong>Methods: </strong>A cross sectional study performed after institutional ethics committee clearance. Total 205 pregnant females were enrolled in study by simple random sampling. Complete history, clinical examination and relevant investigations were done. Patients were treated accordingly. Data was analysed by application of descriptive analysis, Mean and SD.</p><p><strong>Results: </strong>In physiological changes, linea nigra was the most common, followed by striae distensae. Pigmentary changes were found more commonly in 2^nd trimester while vascular and structural changes were commoner in 3^rd trimester. In dermatoses affected by pregnancy, fungal infection was most common followed by viral infections and acne which were most commonly seen in 2^nd trimester. Polymorphic eruption of pregnancy was most common among pregnancy specific dermatoses followed by pruritus gravidarum which were more commonly noted in the 3^rd trimester. Atopic eruption of pregnancy was common in 2^nd trimester. As study was cross sectional, disease progression and treatment outcome could not be observed.</p><p><strong>Conclusions: </strong>Cutaneous lesions<strong> </strong>may range from common, benign changes termed physiological or more severe, posing significant risk to mother and child. Timely diagnosis and prompt treatment is essential for improving maternal and fetal well-being and prognosis and to minimize their morbidity.<strong></strong></p>

The skin in pregnancy

Dermatoses in pregnancy are common, they may be very itchy and may influence the life of a pregnant woman dramatically. There are four classical dermatoses of pregnancy, which this chapter will examine. It is particularly important to recognize these as they may have serious health implications for mother and child. Intrahepatic cholestasis of pregnancy occurs in 1/40 to 1/500 pregnancies and is the most serious cause of itch in pregnancy, with potentially substantial effects on mother and fetus. Meanwhile, atopic eruption of pregnancy affects 1/300 pregnancies, typically with an eczematous eruption over abdomen and limbs. Pemphigoid gestationis occurs in 1/50,000 pregnancies and is due to circulating antibodies against the skin basement membrane zone. The eruption often begins around the umbilicus and spreads to the whole trunk, limbs, hands, and feet. If potent topical steroids fail systemic steroids are required. Transplacental transmission to the fetus may also occur. Recurrence in future pregnancies is to be expected.

Dermatoses Of Pregnancy: A Retrospective Cohort Study In Spain

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.

Dermatoses of pregnancy. A prospective study from Benghazi, Libya

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.

Dermatological manifestations in pregnancy with primary psychiatric findings

IntroductionEven though the association between dermatological conditions in pregnancy with psychiatric findings is vital for patient management, studies on these issues are limited.ObjectiveTo determine the frequency and nature of dermatological problems in pregnant women having primary psychiatric illness.AimTo establish an association between cutaneous manifestations in pregnancy with the hypothesis that psychiatric illness also has a role in pregnancy.MethodsThis was a case control study and non probability convenient sampling was used on 50 pregnant patients with cutaneous manifestations along with psychiatric illness and 50 age matched non pregnant patients free from dermatological conditions and psychiatric illness. The Diagnostic and Statistical Manual of Mental Disorders (DSM IV) Criteria was used to diagnose psychiatric illness and for skin manifestations patients underwent a physical examination of skin.ResultsPregnant patients with depressive disorders were associated with atopic eruption of pregnancy [odds ratio (OR) 1.19; 95% (CI): 1.13–1.49], pruritic urticarial papules [(OR) 2.89; 95% (CI): 2.55–2.97], plaques of pregnancy [(OR) 2.14; 95% (CI): 2.01–2.39], prurigo of pregnancy [(OR) 1.33; 95% (CI): 1.17–1.45], intrahepatic cholestasis of pregnancy [(OR) 2.45; 95% (CI): 2.29–2.67], pemphigoid gestationis [(OR) 1.57; 95% (CI): 1.50–1.68], impetigo herpetiformis [(OR) 1.83; 95% (CI): 1.65–2.24], and pruritic folliculitis of pregnancy [(OR) 2.34; 95% (CI): 2.20–3.62], psoriasis [(OR) 1.75; 95% (CI): 1.64–2.37], melasma [(OR) 1.88; 95% (CI): 1.63–2.49], intrahepatic cholestasis [(OR) 2.77; 95% (CI): 2.14–3.48].ConclusionThe results of the study support the hypothesis, that there is an association between psychiatric and skin diseases in pregnancy.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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

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.