Pregnancy dermatoses2009.08.11 Physiologic skin changes in pregnancy Dermatoses exacerbated by pregnancy Dermatoses only occurring in pregnancy Specific dermatoses of pregnancyPhysiologic skin changes in pregnancy 妊娠期皮肤的生理变化Hyperpigmentation 色素沉着 Occurs in 90% of pregnant women Increased melanocyte-stimulating hormone Accentuation on areolae, genital skin, and linea alba Usually regresses postpartumMelasma 黄褐斑 Occurs in 70% of pregnant women Also seen with oral contraceptivetherapy Centrofacial, malar, and mandibular patterns Excessive melanin in epidermis or dermal macrophages Worsens with UVB exposureHirsutism 多毛症 Face, limbs, and back Regresses within 6 months postpartum Slowed conversion from anagen to telogen hairsNail changes 甲改变 Transverse grooving Brittleness Distal onycholysisIncreased eccrine gland activity内分泌腺活性增加 Miliaria Dyshidrotic eczema HyperhidrosisDecreased apocrine gland activity 大汗腺活动性减少 Hidradenitis suppurativa alleviatedIncreased sebaceous gland activity 皮脂腺活动性增加 Exacerbation of acne vulgaris Montgomerys tubercles enlargeStriae distensae妊娠纹 Occur in 90% of pregnant women Pink or purple atrophic longitudinal bands Caused by increased adrenocortical activity Fade postpartum to persistent pale atrophic bandsVascular changes血管变化 Spider nevi Palmar erythema Nonpitting facial edema Venous varicosities: Legs Vasomotor instability Dermographism Edema and hyperemia of gingivaeDermatoses exacerbated by pregnancy 妊娠期加重的皮肤病Atopic eczema 特应性皮炎 May deteriorate or remit during pregnancy limbs and/or trunk and face May present for the first time in pregnancy in predisposed person Irritant hand dermatitis and nipple eczema common postpartum Treatment: topical corticosteroids, emollients, UVBPsoriasis 银屑病 Most common type : chronic plaque psoriasis Differential diagnosis of pustular variant from impetigo herpetiformis may be difficult Topical treatment: Dithranol, calcipotriol, tar, and corticosteroids are all safe in pregnancy Systemic drugs: retinoids, methotrexate, and hydroxyurea are all contraindicated in pregnancy. Cyclosporine should be used with caution during pregnancy and breast-feeding.Acne vulgaris寻常痤疮 Urticaria荨麻疹 Lichen planus扁平苔藓Infections 感染性皮肤病 Viral (herpes simplex, varicella zoster) Bacterial (impetigo, trichomoniasis, leprosy) Fungal (candidal, Pityrosporum folliculitis) AIDSLupus erythematosus (LE) Debate continues ：whether lupus flares are more common in pregnancy. Cutaneous flares are the most common, followed by arthritis. Painful vasculitic lesions on the peripheries are the most common skin lesions. Neonatal LE is seen in babies of mothers with circulating anti- Ro(SSA) antibodies and can lead to congenital heart block. The antiphospholipid syndrome presents with thrombosis, recurrent miscarriage, livedo reticularis, migraine, stroke, and/or thrombocytopenia. Treatment with systemic corticosteroids and antimalarials should not be stopped in pregnancy, to prevent an acute flare.Systemic sclerosis Polymyositis/Dermatomyositis PemphigusCutaneous tumors affected by pregnancy Pyogenic granuloma Hemangioma Hemangioendothelioma Glomus tumor Dermatofibroma Leiomyoma Keloid Neurofibroma Nevi MelanomaDermatoses only occurring in pregnancy 仅发生在妊娠期的皮肤病Impetigo herpetiformis疱疹样脓疱病 Reminiscent of pustular psoriasis, no prior history of psoriasis Associated with hypoparathyroidism and hypocalcemia Systemic upset with malaise, fever, delirium, diarrhea, vomiting, and tetany secondary to hypocalcemia Erythematous patches with pustular margin in flexural distribution Sparing of face, hands, and feet Postinflammatory hyperpigmentation common Histopathologic features identical to pustular psoriasis with spongiform pustules of Kogoj, large collections of neutrophils within foci of spongiotic epidermis Laboratory findings: Elevated leukocyte count and erythrocyte sedimentation rate, hypocalcemia Treatment: Prednisolone 30-40 mg daily Prognosis: Stillbirth and placental insufficiency still frequently seen even when disease is apparently controlled. Remission postpartum but recurrence in successive pregnancies occurs frequently.Intrahepatic cholestasis of pregnancy 妊娠期肝脏内胆汁郁积Increased incidence Presents in third trimester with severe intractable pruritus Clinical : Often only excoriations; clinical jaundice rare; mal-absorption of fat can lead to weight loss and vitamin K deficiency in severe cases Usually nonresponsive to antihistamines and topical emollients Histopathologic findings: Skin findings nonspecific; liver biopsy specimen will reveal typical changes in severe cases with dilated bile canaliculi, staining of parenchyma with bile pigments and minimal inflammation. These changes are reversible postpartum. Pathophysiology: Associated with HLA subtype B8 and BW16 and positive family history in up to 50% of cases. Physiologic concentrations of estrogens thou