Dermatological emergencies in pregnancy

Abstract

Pregnancy is a state of complex immunological, endocrinological, metabolic, and vascular changes. These changes can manifest on the skin in the form of various disorders. Dermatological emergencies in pregnancy are often a challenge in terms of both making a diagnosis and choosing the treatment modality. Due to overlapping features in some disorders, it is essential to be aware of certain diagnostic pointers to each of these. Furthermore, treatment of skin diseases in pregnancy entails that a dermatologist takes a holistic approach. Consideration of well-being of both mother and fetus is of prime importance. The specific dermatoses of pregnancy are a heterogenous group of inflammatory skin diseases characterized by severe itching with skin lesions of varying morphology, occurring exclusively during pregnancy and the postpartum period. The revised classification by Rudolph et al. includes pemphigoid gestationis, polymorphic eruption of pregnancy, atopic eruption of pregnancy, and intrahepatic cholestasis of pregnancy. Impetigo herpetiformis or generalized pustular psoriasis of pregnancy is a rare life-threatening pustular dermatosis related to pregnancy. Systemic lupus erythematosus is associated with a high risk of intrauterine growth retardation, preterm labor, fetal loss, and perinatal mortality. As drug trials in pregnancy are considered unethical, the safety of drugs in pregnancy is often determined from retrospective case series, reports, and animal studies. Hence, there is limited evidence regarding the safety of many drugs. To conclude, a dermatologist often encounters a pregnant female with cutaneous disorders. When these conditions present as emergencies, the management can be challenging.