Lecture By: Dr. HUSSEIN ABOUL FOTOUH Dermatologist Al Meeqat General Hospital Almadina Almunawara

3. SKIN CHANGES AND
DERMATOSES OF
PREGNANCY
Dr. HUSSEIN ABOUL FOTOUH
Dermatologist
Al Meeqat General Hospital
Almadina Almunawara

5.  During pregnancy immunologic endocrine
metabolic and vascular changes occur that
make the pregnant woman susceptible to skin
changes both physiologic and pathologic.
 They are
 A-Physiologic skin changes
 B-Dermatoses aggravated by pregnancy
 C-Dermatoses of pregnancy

7. Physiologic skin changes
 Caused by the hormonal changes of
pregnancy
 1-Pigmentary changes
 (usually regress postpartum)
 -Diffuse hyperpigmentation(90% with
accentuation of normally hyperpigmented
areas e.g. areolae axillae linea alba
 -Melasma(70% of pregnant)
 -Darkening of nevi
 -Pigmentation of axillae and inner thighs

9.  2-Hair changes (hirsutism postpartum
telogen effluvium postpartum male pattern
alopecia)
 3-Nail changes (subungual hyperkeratosis
distal onycholysis transverse grooving and
brittleness)
 4-Glandular
 -Increased eccrine activity (hyperhidrosis
miliaria and dyshidrotic eczema)
 -Decreased apocrine activity )(hidradenitis
suppurativa)
 -Increased sebaceous activity (exacerbation
of AV enlarged Montgomery follicles of
areolae)
 5-Striae distensae or atrophicae

17. Vascular(spider nevi palmar erythema-6
nonpitting facial edema varicosities
(dermographism and haemorrhoides
Gingival hyperemia and gingivitis-7
Prurigo gravidarum due to functional-8
hepatic disturbance induced by estrogens

23. Dermatoses aggravated by pregnancy
 1-Infections ( severe seborrhoeic dermatitis or orovulval
candidiasis should raise suspicion of HIV during pregnancy)
 -Viral (H. simplex- condyloma accuminata ( cs is
indicated for both)- varicella zoster)
 -Bacterial (leprosy)- protozoan (trichomoniasis)
 -Fungal (Candida -pityrosporum folliculitis)
 .AIDS pregnancy accelerates the development of
AIDS in an asymptomatic HIV +ve patient.
 2-Inflammatory disorders
 -Atopic dermatitis–acne vulgaris –Hidradenitis
suppurativa –Chronic plaque psoriasis –Fox
fordyce disease (all may improve) -urticaria

26.  3-Autoimmune diseases -SLE –
Dermatomyositis
 -Pemphigus vulgaris – Systemic sclerosis
 -Rheumatoid arthritis (improve)
 4-Metabolic diseases
 -Porphyria cutanea tarda – Acrodermatitis
enteropathica
 5- Connective tissue disorders
 -Ehler Danlos syndrome – Pseudoxanthoma
elasticum
 6- Tumors
 -Pyogenic granuloma –Glomus tumor –
Hemangioma –Hemangioendothelioma –
dermatofibroma –neurofibroma -melanoma

29.  7-Miscellaneus –Sarcoidosis (may improve
during pregnancy) –Mycosis fungoides
-Neurofibromatosis
Erythrokeratoderma variabilis

32.  DERMATOSES OF PREGNANCY(6)
 1-Intrahepatic cholestasis of pregnancy (ICP)
 2-Impetigo herpetiformis (IH)
 3-Herpes gestationis (HG)
 4-Pruritic urticarial papules and plaques of
pregnancy (PUPPP)
 5-Prurigo of pregnancy (PP)
 6-Pruritic folliculitis of pregnancy (PFP)

33. Intrahepatic cholestasis of pregnancy
 It is seen in the third trimester ( unlike physiologic
prurigo gravidarum which occurs in the first
trimester) . It is characterized by
 -Elevated liver function tests and serum bile acids
 -Generalized pruritus ( high bile salts) and
excoriations (without primary skin lesions) with jaundice in
50% of cases that resolves after delivery
 -Malabsorption of fat with weight loss vitamin k
deficiency------- IU Hge
 -Increased fetal distress and stillbirths
 -50% recurrence with subsequent pregnancies
 TTT emollients cholestyramin UVB evening primrose
oil.

34. (IMPETIGO HERPETIFORMIS(IH
 A variant of pustular psoriasis( histopathologically)
characterized by widespread sheets of
erythema with pustular margin starting
in flexures sparing face hands and feet there is
fever diarrhea and vomiting.
 -It starts usually in the third trimester and resolves
postpartum but may recur with subsequent
pregnancies
 -associated with hypocalcaemia high ESR and
leukocytosis.
 TTT prednisolone 40 mg daily calcium and
termanination is indicated (stillbirth and placental
insufficiency).

36. Herpes gestationis (HG( an autoimmune bullous
:disorder closely related to Bullous pemphigoid .Onset
 -second or third trimester .Recurrence is common
with subsequent pregnancies and oral contraceptives
 -Intensely pruritic erythematous plaques on the
abdomen periumblical----------generalized bullous
eruption sparing face mucous membranes palms and
soles
 -Histopathology subepidermal separation basal cell
necrosis eosinophilic spongiosis.
 Direct Immuno Fluorescence shows linear c3 and IgG
at BMZ
 HG factor is a circulating IgG Ab. that binds toAg2 in
BMZ the same antigen is found in the placenta.It
stimulates complement pathway----c3 deposition at
BMZ---chemotaxis of eosinophils----proteolytic
enzymes-----dermoepidermal separation

37.  TTT mild cases potent topical steroids
and systemic antihistamines
 -prednisone 20—40mg daily
 -Plasmapheresis
 NB Avoid dapsone-----neonatal
hemolysis and avoid oral
contraception-------HG recurrences

42. PRURITIC URTICARIAL PAPULES AND PLAQUES OF
PREGNANCY (PUPPP( SYN. POLYMORPHIC ERUPTION
OF PREGNANCY
 The most common 1to 300 preg.
 -occurs in primigravidas in the third
trimester and does not usually recur in
subsequent pregnancies.
 -severely pruritic polymorphous eruptions
(urticarial-papules-plaques-and erythema
multiforme like lesions) usually begin in the
striae on the abdomen and spreading
peripherally .The face palms and soles are
commonly spared.It resolves after delivery.
 -HISTOPATHOLOGY mild spongiosis and superficial
perivascular inflammatory cell infiltrate with many

43. Pathogenesis
Rapid abdominal distention in primigravidas in
third trimester may cause damage to
connective tissue in the striae and trigger the
.inflammatory response to PUPPP
.It is harmless to the fetus and mother-
TTT Antihistamines – short course of oral
prednisone –topical steroids and antipruritics-
UVB therapy

47.  PRURIGO OF PREGNANCY (PP)
 -Onset 2nd or 3rd trimester with no recurrence with
subsequent pregnancy.
 -Clinically pruritic papules or nodules on extensors of
limbs or abdomen (similar to nodular prurigo) as
there may be an atopic background. No
complications.
 -TTT topical steroids – antihistamines – resolution
-----weeks after pregnancy

49.  PRURITIC FOLLICULITIS OF PREGNANCY(PFP)
 -Onset 2nd or 3rd trimester with no recurrence with
subsequent pregnancy.
 -Clinically similar to steroid acne (pruritic
erythematous follicular papules on limbs and
abdomen).
 -No complications
 -TTT Topical steroids – Resolution is postpartum

52. THANK YOU