56 - Skin Disease and Pregnancy

Abstract

Skin changes in pregnancy can be categorized into physiologic skin changes, preexisting skin disease affected by pregnancy, pruritus in pregnancy, and specific dermatoses of pregnancy. Physiologic skin changes include pigmentary, vascular, mucous membrane, hair, nail, and glandular changes. Such changes are expected to resolve postpartum. The pregnant woman is susceptible to aggravation or, less often, improvement of preexisting skin diseases, including inflammatory, such as atopic dermatitis, bullous, and connective tissue disorders. Benign tumors can develop during pregnancy and may resolve postpartum. Pruritus is the most common cutaneous symptom of gestation. The diagnosis of intrahepatic cholestasis of pregnancy should be considered in the absence of pruritic skin disease and systemic diseases complicated with pruritus. Specific dermatoses include pemphigoid (herpes) gestationis, polymorphic eruption of pregnancy, prurigo of pregnancy, and pruritic folliculitis of pregnancy. A proposed reclassification grouped atopic dermatitis (preexisting or appearing for the first time during gestation), prurigo, and pruritic folliculitis of pregnancy under the umbrella concept of “atopic eruption of pregnancy” (AEP) based on evidence of atopic predisposition in patients with such skin diseases. The AEP term can be applied when there is a clear atopic predisposition in a patient with such skin disease. Still, many cases of prurigo of pregnancy have not been associated with atopy. Cholestasis of pregnancy is associated with substantial fetal risks, whereas fetal risks are mild in pemphigoid gestationis. The pregnant woman should be counseled about the nature of her skin condition, possible maternal or fetal risks associated with it, and management options.