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Pregnancy Dermatoses
Kelly K. Park, MD, MSL & Monika Kanizewska, MD, MS

Risk Fetal
Dermatosis Description Timing Location Factors Treatment Pathology Involvement
Pemphigoid Pruritic Classically Abdomen, HLA-DR3, Self-limited; Subepidermal risk of
gestationis vesiculobullous late pregnancy, umbilicus, HLA-DR4 topical and vesicle mixed prematurity,
eruption but can occur can systemic cor- infiltrate with small-for-
Herpes in any generalize May flare or ticosteroids, eosinophils gestational age
gestationis* Spontaneously trimester, or
have recur- antihista- neonates,
remits weeks immediately Spares
to months after postpartum mucous rence with mines DIF: Linear C3 neonatal
delivery membranes menses, oral + IgG along pemphigoid
Commonly contraceptives BMZ gestationis
recurs in
subsequent [Note: Indirect IF: IgG
pregnancies Patients are autoantibodies
at risk against BMZ
for Graves
Disease] Salt-split
skin test:
Epidermal
Polymorphic Pruritic End of third Within Primipara, Self-limited; Non-specific, None
eruption of erythematous trimester, abdominal maternal resolves negative IF
pregnancy and edematous immediately striae, can weight gain, within 4 and ELISA
(PEP) papules and postpartum generalize multiple weeks,
plaques that
gestation topical
Pruritic may become Spares
urticarial vesicular, umbilicus, pregnancy corticosteroids,
papules and targetoid, face, palms, antihistamines
plaques of eczematous soles
pregnancy,
PUPPP*

Atopic erup- Flare or Commonly Can be in Atopic Topical Variable, but None
tion of preg- new onset prior to third a flexural diathesis corticosteroids, commonly
nancy (AEP) eczematous or trimester distribution ultraviolet B spongiosis,
papular eruption (UVB) acanthosis,
in atopics Commonly
phototherapy lymphocytic
recurs in
May have serum subsequent and
IgE elevation pregnancies eosinophilic
infiltrate
Kelly K. Park, MD, MSL,
is a PGY-3 dermatology
resident at Loyola
University Medical
Center in Maywood, Pruritic fol- Follicular-based After first Trunk > Atopy Post-partum Sterile None
Illinois. liculitis of papules and trimester extremities has been resolution folliculitis
pregnancy pustules suggested
May recur in
subsequent
May be
pregnancies
a variant
of Atopic
Eruption of
Pregnancy

Prurigo of Prurigo nodules After first Extremities > Atopy has Resolves Varies None
pregnancy trimester abdomen been post-partum
May have serum suggested
Monika Kaniszewska, IgE elevation May recur in
MD, MS, is a PGY- subsequent
May be
4 dermatology resident pregnancies
a variant
at Loyola University of Atopic
Medical Center in Eruption of
Maywood, Illinois. Pregnancy

DRirections
in
esidency p. 4 Fall 2014
 boards fodder
Pregnancy Dermatoses (cont.)
Kelly K. Park, MD, MSL & Monika Kanizewska, MD, MS

Risk Fetal Boards

Dermatosis Description Timing Location Factors Treatment Pathology Involvement
Fodder
Intrahepatic Pruritus, may Late second Starts on Endemic Resolves Nonspecific risk of
cholestasis have secondary trimester, palms clusters, within days premature In addition to this
of pregnancy lesions third trimester and soles, positive family of delivery; labor, fetal issues Boards
(ICP) (excoriations, spreads to history, ursodeoxy- distress,
prurigo); Recurrence in extensor Fodder, Pregnancy
multiple- cholic acid stillbirth Dermatoses, dont
Cholestasis jaundice subsequent extremities,
of pregnancy, pregnancies abdomen, gestation (UDCA)
pregnancies,
forget to download
obstetric Elevated serum buttocks
cholestasis bile acids ABCB4 muta- the new Boards
(OC) tion, hepatitis Fodder online
C virus (HCV) exclusive from
infection, www.aad.org/
selenium
deficiency,
DIR, where a new
intestinal chart is published
permeability each quarter. The
Fall 2014 online
May have Boards Fodder is
recurrence
with oral
Autoinflammatory
contraceptives syndromes by
Sailesh Konda, MD
Autoimmune Progesterone Varies Varies None Symptomatic, Dependent on Spontaneous
progesterone hypersensitivity reported can include morphology abortion has and Sasank Konda,
dermatitis characterized by antihistamines, been reported BA.
(AIPD) a cyclical topical and
eruption related
to menses
oral corti- To view, download,
costeroids, or print every
May worsen or epinephrine
Boards Fodder
improve during prn
pregnancy ever published,
both in print and
online, check
Generalized Pustules on Third Flexural Unclear, Systemic Pustular Low birth out the com-
pustular erythematous trimester surfaces may include cortico- psoriasis: weight,
psoriasis of patches that (inguinal), plete archives at
hypocalcemia, steroids; spongiform intrauterine
pregnancy form polycyclic Recurs with spread to hypovitaminosis resolves pustules, growth www.aad.org/
erythematous subsequent trunk and BFarchives.
D, stress, postpartum neutrophils, restriction,
Impetigo patches and pregnancies proximal
herpetiformis plaques with extremities bacterial superficial premature
(IH) peripheral infections perivascular rupture of
pustules lymphocytic membranes,
and neutro- stillbirth,
philic infiltrate neonatal death

* historical nomenclature
may be considered as under the classification of AEP
synonym(s)

Physiologic cutaneous changes in pregnancy

Mucosal: Chadwicks sign (blue-to-violaceous discoloration of mucous membranes of cervix, vagina, vulva)
First Trimester Vascular: gingival hyperemia and edema, palmar erythema, spider angiomas
Glandular: hypertrophy of Montgomery tubercles, sweating

Pigmentary changes
Second Trimester
Pruritus (late)

Pruritus (early)
Hair and nail changes
Third Trimester
Connective tissue changes
Vascular: edema, purpura, petechiae

References
1. Kroumpouzos G, ed. Text Atlas of Obstetric Dermatology. Philadelphia, PA: Lippincott, Williams & Wilkins; 2014.
2. Bolognia JL, Jorizzo J, Schaffer JV, ed. Dermatology, Third Edition: Elsevier Limited; 2012.
3. Ambros-Rudolph CM, Mullegger RR, Vaughan-Jones SA, Kerl H, Black MM. The specific dermatoses of pregnancy revisited and reclassified: results of a
retrospective two-center study on 505 pregnant patients. Journal of the American Academy of Dermatology 2006;54:395-404.

www.aad.org/DIR Fall 2014 p. 5 DRirections

in
esidency