Pregnancy Dermatoses CS-OSPE
Pemphigoid Gestation / Herpes Gestationis (formerly Pemphigus Gestation)
Description/Clinical Features: Pregnant woman Itchy umbilicus, pruritic eruption On her 21 weeks of her pregnancy Involves the umbilicus Subepidermal Blister - Papule - Vesicles - Bullae A multipara lady on her 21 weeks of her pregnancy developed a pruritic eruption. A 35-year-old pregnant woman, G1P0, in her second trimester, presented to the ER with a widespread severe pruritic eruption that involved all the body. On examinations, a few bullae were found on her upper thighs. Her GP tried antipruritic treatments including antihistamines, emollients, and topical steroids without noticeable improvement.
- From the picture and description, what are important clinical features of this condition?
- Widespread pruritic eruption (papules, vesicles, bullae)
- Subepidermal blisters
- Often involves the umbilicus (a key differentiating feature from PUPPP, which usually spares the umbilicus)
- Commonly occurs in the second trimester of pregnancy
Diagnosis:
- Pemphigoid gestationis / Pemphigus gestation (also known as Herpes Gestationis)
Differential Diagnosis (DDx):
- PUPPP (Pruritic Urticarial Papules and Plaques of Pregnancy)
Confirmatory Test: * Direct Immunofluorescence (DIF): * Expected finding: A linear band of C3 +/- IgG at the basement membrane zone.
Support Diagnosis:
- Umbilical involvement
-
- Direct Immunofluorescence
Treatment:
- Topical steroids mild cases
- Systemic steroid / Oral prednisone if severe (e.g., Prednisone), especially if topical steroids didn’t improve the patient or in severe/widespread cases.
- (Okay for pregnancy to give systemic)
Complications:
- Preterm labor / Preterm delivery
- Postpartum severe eruption may occur
- Low birth weight / Small-for-gestational age infants
- Fetus acquires it too / Blister in neonate
- Recurs in later pregnancy / Recurrency
Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP)
Diagnosis:
- Pruritic urticarial papules and plaques of pregnancy (PUPPP)
Characteristic:
- Does not involve the umbilicus
Treatment:
- Topical steroid
- In severe case, oral prednisone
- Anti-histamine
What is false (regarding recurrence):
- Recurrence at next pregnancy (implies it usually does not recur)
Differential Diagnosis (DDx):
- Pemphigoid gestationis
Intense, non-remitting pruritus without skin lesions, itch is worse after a hot shower
Case 15: Intrahepatic Cholestasis of Pregnancy (ICP)
Diagnosis Intrahepatic Cholestasis of Pregnancy (ICP)
Differential Diagnosis
- Alcoholic hepatitis
- Drug-induced hepatitis
- Biliary obstruction
- Primary biliary cirrhosis
Description No skin lesions
Pathophysiology Due to increased levels of estrogen
Estrogen Effects
- Promotes cholestasis
- Inhibits reuptake of bile acids into hepatocytes
- Inhibits bile transport proteins
Complications for the Mother
- Bleeding
- Intestinal malabsorption
- Cholelithiasis.
Complications for the Fetus
- Prematurity
- Fetal distress
- Death.
Goal of Treatment
- Decrease circulating bile acids
- Reduce symptoms
- Prevent maternal and fetal complications
Management
- Full history
- Examination
- Education
- Ursodeoxycholic acid
- Vitamin K supplementation
- When cholestasis is severe, delivery is considered earlier if fetal lung maturity is established
Melasma (Pregnancy-related)
Clinical Presentation: This lady presented with this facial discoloration which she developed during her first gestation. Name:
- Melasma Treatment:
- k ligman regime