What are defining characteristics of polymorphic eruption of pregnancy (PEP)/pruritic urticarial papule and placques of pregnancy (PUPPP)?
- excoriated papules that starts along abdominal striae
- spreads to thighs, buttocks, arms, legs
- spares periumbilical area (halo), face, palms, soles, mucous membranes
What does PEP/PUP typically present?
third tri or immediately postpartum
How is PEP/PUPPP treated?
- emollients
- topical corticosteroids
- PO antihistamine
- menthol
- typically resolves 1-6wks PP*
What are risks associated w/ PEP/PUPPP?
none
What are risk factors for PEP/PUPPP?
- atopic constitution (e.g. asthma, allergies, eczema)
- multiple gestation
- excessive weight gain
How is PEP/PUPPP dx’ed?
no dx testing
R/O PG, cholestasis
What are defining characteristics of prurigo of pregnancy (PP)?
- grouped, crusted, erythematous papules, patches, plaques; often excoriated
- extensor surface of arms, legs, abdomen
When does PP present?
b/w 25-30wks
What are PP differentials?
- pre-existing atopic s/sx
- scabies
- insect bites
- eczema
- drug-related rash
How is PP managed?
- topical corticosteroid cream
- PO antihistamine
- 3-10% urea emollient
- narrow band UVB tx
- typically resolves several weeks PP but may last for 12wks*
What are defining characteristics of pruritic folliculitis of pregnancy (PFP)?
- papules, pustules around hair follicles
- start on abdomen/trunk –> extremities
- +/- pruritus
When does PFP present?
rare
2nd or 3rd tri
What are differentials for PFP?
R/O
- PEP: no urticaria, lesions in striae
- PG: no bullous lesions
- acne: no lesions on face
- drug rxn
How is PFP managed?
- no pruritis = no tx
- symptomatic: topical steroid or UVB light
- resolves late in pregnancy or by 2wk PP*
What skin conditions does atopic dermatitis include?
- acne
- psoriasis
- eczema
What are defining characteristics of atopic dermatitis?
- lesions on UE/LE on flexor surfaces, trunk, hands, feet, nipples
- more widespread than in PP
- no primary lesions
- secondarily: erythema, scaling, lichenification, papules
- excoriation: oozing, weeping, secondary bacterial infection
When does atopic dermatitis present?
early in pregnancy - typically becomes worse during pregnancy in pts w/ pre-existing condition
What are risk factors for actopic dermatitis?
- hx of atopy
- family hx of atopy
- children w/ infantile atopic dermatitis
- African-American
- Asian
- smoking
How is atopic dermatitis managed?
- emollients
- PO antihistamines
- UV light
- mild topical steroids; PO steroids use sparingly, esp in 1st tri
What are defining characteristics of pemphigoid gestationis (PG)?
- severe pruritus
- urticarial, erythematous papules in periumbilical region and extremities
- not on face, palms, soles, mucous membranes
- papules change to placques –> form tense blisters (“bullous lesions”)
- blisters erupt –> yellow or hemorrhagic crust forms
What is the pathophysiology of PG?
autoimmune
IgG attacks transmembrane glycoprotein
begins in placenta; impacts skin
How is PG dx’ed?
- biopsy
- direct immunofluorescence (DIF) to detect C3 protein deposits –> r/o drug eruptions, contact dermatitis, bullous pemphigoid, erythema multiforme
- IgG presence
- ELISA to detect PG Abs
When does PG present?
rare
2nd and 3rd tri
usually in first pregnancy
*typically recurs in subsequent pregnancies - begins earlier, lasts longer *
How is PG managed?
- pre-blistering stage: emollients, high-potency topical steroids, PO steroid (prednisone)
- blisters: PO prednisone to reduce pruritus and new blister formation; PO 1st gen antihistamine in 1st tri
- eruptions resolve w/in 4wks PP*
- urticaria may last up to 14wks PP*
