Descriptive Study of Pregnancy Dermatoses in Central Region of Gujarat

BACKGROUND The present study was conducted to evaluate the incidence, clinical presentation, course and prognosis of physiological changes of pregnancy i.e. to study the incidence of different dermatoses during pregnancy, cutaneous manifestations associated with pregnancy according to trimester and parity of pregnancy, specific dermatoses of pregnancy, the presence of same or other diseases in the past pregnancy, and observe the relative effect of pregnancy on already existing dermatoses or which are basically not related to pregnancy. METHODS A random hospital based descriptive study of 80 patients with pregnancy, who attended skin outpatient department (OPD) in GMERS Medical College, Himmatnagar, Gujarat, India, was done. Detailed history was taken, and each patient was examined thoroughly. General- and systemic-examination were done and whenever necessary, relevant investigations were done. RESULTS A total of 80 patients were included in the study. Of them 39 (48.7 %) were primipara and 41 (51.3 %) were multipara. Skin changes were grouped into physiological changes (all cases), specific dermatoses (17 cases) and other dermatoses (52 cases). Most common physiological changes were related to pigmentation followed by striae gravidarum. Physiological changes were observed in almost all the patients. CONCLUSIONS Pregnant women are prone to suffer from a wide range of dermatological problems apart from the specific dermatoses of pregnancy. Detailed history and awareness of clinical presentation facilitates the confirmation of diagnosis and will direct the most appropriate laboratory evaluation in an effort to minimize maternal and foetal morbidity. KEYWORDS Pregnancy Dermatoses, Specific Dermatoses, Physiological Changes

A review of literature of polymorphic eruption of pregnancy

<p class="abstract">Polymorphic eruption of pregnancy (PEP), also known as pruritic urticarial papules and plaques of pregnancy [PUPPP] is the most common of all the specific dermatoses of pregnancy. It is a benign, self-resolving, pruritic disorder of pregnancy, usually affecting primigravida during the last trimester of pregnancy or immediately postpartum. Its exact pathogenesis is still unknown, and its clinical presentations are variable. It may mimic many common dermatoses. In PEP, the histological findings are non-contributory and the laboratory results, including direct and indirect immunofluorescence are negative. Diagnosis mainly depends on clinical findings. Significant diagnostic confusion may occur with early lesions of pemphigoid gestationis, which needs to be differentiated from PEP as the former may have a bad fetal outcome. PEP is not associated with any fetal or maternal risk, and symptomatic treatment is all that is usually required. The awareness of this condition helps the physician recognize this entity, reassure the patient, and avoid unnecessary investigations. This review focuses on etiology, various clinical presentations, differential diagnosis, and management of PEP.</p>

Acquired Factor XI Deficiency with Lupus Anticoagulant in a Pregnant Woman Diagnosed by the Eruptions and Pain in Fingers

We report a case of acquired factor XI deficiency with lupus anticoagulant (LA) in a 28-year-old primigravida who presented with finger pain and eruptions on her palms and fingers during the 3rd trimester of pregnancy. The patient complained of pain and reddening of the fingers at 30 weeks of gestation. She was referred to our tertiary center with a diagnosis of preeclampsia and suspected collagen disease at 35 weeks of gestation. Erythema was seen on the fingers and palms, and she presented with pain and cryesthesia on the fingers. Laboratory investigations revealed an activated partial thromboplastin time of 51 s (normal, 23–40 s), although it was normal during the 30th and 34th gestational weeks, LA with an anticardiolipin-beta2-glycoprotein I complex antibody, and low level of clotting XI activity (25 U/mL). On week 37 day 0 of gestation, the patient presented with severe hypertension. An urgent Cesarean section was performed after transfusion of two units of fresh frozen plasma. There was no excessive bleeding during the surgery or the postpartum period. The symptoms on her fingers and palms gradually improved after surgery. Our case indicates that dermatoses of pregnancy may become a starting point for the diagnosis of autoimmune diseases and coagulation abnormalities. When a patient presents with an atypical symptom, as in our case, the possibility of various diseases should be considered.

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.

Dermatological Conditions Associated with Pregnancy: A Hospital Based Study

Background: Pregnancy Changes can be both physiologic and pathologic, affecting commonly the skin, nails, and hair shafts. Pregnancy has immunologic, endocrine, metabolic and vascular changes, which leads to changes of skin and its appendages and can affect every organ of pregnant women including the skin. Pregnancy also modifies the course of a number of preexisting dermatological conditions. The aim of our study was to study the common skin manifestation Objectives: during pregnancy. Material and Method: Hundred pregnant women were enrolled in the study. This is a hospital- based prospective cross- sectional descriptive study, conducted in the out-patient department (OPD) of Department of Dermatology and Venereology and Department and Obstetrics and Gynecology at Nepalgunj Medical College Teaching Hospital Kohalpur, Banke Nepal, conducted over a period of two year, June 2016 to May 2018. A detailed history along with complete cutaneous examination was carried out in all patients. Relevant investigations were done wherever necessary. Result: A total of 100 pregnant women were recruited in our study from June2016 to May 2018. Out of these, 65(65%) were primigravidas and 35(35%) were multi gravidas. Their age range was 18 to 37 years with the mean of 24. Most of them presented in the third trimester. Pruritus was the commonest symptom accounting for 28(28%)cases. Physiological changes were seen in 75(75%) cases and 10 (10%) cases of specific dermatoses of pregnancy were seen. Conclusion: Skin manifestations are quite common in pregnancy and physiological changes were frequently seen. This study emphasizes the need for a scrupulous and meticulous search for dermatological and sexually transmitted diseases instead of a casual cursory examination and clinicians need to distinguish between physiological skin changes and specific dermatoses of pregnancy for better patient care.