Abstract
IntroductionSkin hyperpigmentation is common during pregnancy and often is due to endocrinological changes. Usual patterns include linea nigra, darkening of areola and melasma. We report a rare diffused hyperpigmentation condition in a pregnant woman of dark colored skin.Case presentationA 19-year-old Tanzanian primigravida at 32 weeks gestation presented at our antenatal clinic concerned about an insidious but progressive onset of unusual darkening of her abdominal skin and both breasts. Her antenatal record was unremarkable except for this unusual onset of abnormal skin color. Findings from her physical examination were unremarkable, and she had a normal blood pressure of 120/70 mmHg. Her abdomen was distended with a uterine fundus of 34 weeks. Almost her entire abdominal skin had darkly colored diffuse deep hyperpigmentation extending cephalad from both iliac fossae to involve both breasts to 2-3 cm beyond the areolae circumferentially. She had a fetus in longitudinal lie and cephalic presentation, with a normal fetal heart rate of 140 beats per minute. Other examination findings were unremarkable. The impression at this stage was exaggerated pigmentation of pregnancy. No medical treatment was offered but she was counseled that she might need medical treatment after delivery. She progressed well and had spontaneous labor and normal delivery at 38 weeks gestation. She was lost to follow up.ConclusionUnusual pregnancy-related skin hyperpigmentation can occur with no adverse consequences to pregnancy, although may worry a pregnant woman. Reassurance and conservative management may be all that is required to allay a patient's concerns.
Highlights
Skin hyperpigmentation is common during pregnancy and often is due to endocrinological changes
Unusual pregnancy-related skin hyperpigmentation can occur with no adverse consequences to pregnancy, may worry a pregnant woman
The usual pattern will be seen as linea nigra, melasma and darkening of areola, axillae and medial thighs [1,2,3]
Summary
Hyperpigmentation during pregnancy is commonly due to endocrinological changes. The usual pattern will be seen as linea nigra, melasma and darkening of areola, axillae and medial thighs [1,2,3]. We present a case of an unusual pattern of pigmentation in a primigravida seen in her mid-third trimester, who had an unremarkable pregnancy, labor, delivery and postpartum period. She booked for antenatal care at a peripheral clinic and her progress had been unremarkable except for this unusual onset of abnormal skin color. Almost the entire abdominal skin had dark colored diffuse deep hyperpigmentation, extending from both iliac fossae to involve both breasts (nipples and areolae) to about 2-3 cm beyond the areolae circumferentially (Figure 1) She had a fetus in longitudinal lie, cephalic presentation with a normal fetal heart rate of 140 beats per minute.
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