Physiologic Pregnancy Changes- Pigmentary
- Melasma
- Hyperpigmentation around areolae
- Linea nigra on abdomen
- Darkening of nevi
- Vascular
- Spider angiomas
- Palmar erythema
- Varicosities
- Non-pitting edema
- Pyogenic granulomas
- Hair
- Hypertrichosis (prolongation of anagen phase)
- Postpartum telogen effluvium (synchronized transition into telogen phase)
- Androgenetic alopecia
- Nail
- Connective tissue
Pemphigoid Gestationis (Herpes Gestationis) (Figure 3.39A–C) - Autoimmune bullous dermatosis of pregnancy; typically second or third trimester or immediately postpartum
- Antibody: anti-BPAG2 (BP180, NC16A site)
- Presents with pruritic urticarial papules on trunk (typically periumbilical), may progress to tense vesicles/bullae and spreads peripherally (spares mucous membranes, face, palms and soles); ± flare with delivery (75%); ± recurrence with OCPs, menses or subsequent pregnancy; ↑ mother’s risk for Graves’ disease
- Histology: papillary dermal edema resulting in subepidermal bulla with eosinophil-rich infiltrate, ± keratinocyte necrosis, perivascular infiltrate
- DIF: linear C3 deposition ± IgG at basement membrane (key assay test to differentiate from PUPPP)
- IIF (salt-split): epidermal base (roof of blister like BP)
- Fetal risk: ↑ risk of prematurity, ↑ incidence of small for gestational age birth, up to 10% risk of skin involvement
- Treatment: oral corticosteroid (topical corticosteroid and antihistamine typically ineffective)
- Association: ↑ incidence of anti-thyroid antibodies, ↑ frequency with HLA-DR3, HLA-DR4
| | | | | | Most important pregnancy dermatosis to exclude | | | | | |
|
| | Figure 3.39
A: Pemphigoid gestationis*
B: Pemphigoid gestationis*
C: Pemphigoid gestationis*
*Reprint from Ingber A.
Obstetric Dermatology:
A Practical Guide. New York,
NY: Springer; 2008 |
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