Atopic Eruption of Pregnancy

Atopic eruption of pregnancy is a term that encompasses other pruritic inflammatory dermatoses which appear or worsen during pregnancy:

  • Atopic dermatitis in pregnancy
  • Prurigo of pregnancy (Besnier) = intensely itchy papules
  • Pruritic folliculitis of pregnancy = itchy inflammation around the hair follicle

pastules, bacterial

Diagnosis

  • This is an example of an atopic eruption of pregnancy (prurigo type).

  • Atopic eruption of pregnancy (AEP):

    • Eczematous in 2/3 and prurigo type in 1/3
    • Starts earlier in pregnancy (mean=18 weeks)
    • 80% of patients have a previous history of atopic dermatitis while 20% do not
  • AEP is a clinical diagnosis.

  • Histopathology is non-specific.

  • Immunofluorescence is negative.

AEP: Treatment

  • AEP is a benign disease and does not carry increased maternal or fetal risks.

  • Treatment is largely dependent on controlling the eruption with topical steroids.

  • Oral steroids can be used in recalcitrant cases.

  • If the eruption does not respond to topical steroids, referral to dermatology is recommended.

  • The eruption may persist after pregnancy as a chronic dermatitis.

Case Four: History

  • Sayda is a 25-year-old woman who comes in for an itchy eruption that began two weeks ago.
  • She is 20 weeks pregnant with her second child. Her previous pregnancy was unremarkable.
  • She is healthy and has no history of atopy.

![[Atopic Eruption of Pregnancy AEP-1747728771579.webp]]

Case Four, Question 1
  • The best way to describe her lesions is: a. deep-seated nodules over the legs b. lichenified papules over the legs, some of which are excoriated c. multiple ill-defined scaly plaques d. well-demarcated, scaly macules scattered over the extremities
Case Four, Question 2
  • Sayda is worried that her baby will be affected by her disease. What do you tell her? a. She will need to be monitored as a high-risk pregnancy. b. There have been reports of fetal distress in patients with AEP. c. There is a risk of small-for-gestational age births in AEP. d. There is no need to worry. Fetal distress is not increased in patients with AEP.