Atopic Eruption Of Pregnancy Research Articles

Cutaneous Changes During Pregnancy

Background:There are several changes which affect females’ skin that occur during pregnancy. These changes, although considered, physiological are quite distressing to many women. Discussion with the pregnant woman about the nature of her skin condition and the possible fetal risks associated with it is imperative. Aim of the work: This study aimed to evaluate the pattern of dermatological manifestations which affect pregnant women in our environment with different socio-economic levels. Patients and Methods: This study was a cross- sectional design. It included 600 pregnant women who attended Dermatology, Venereology, Andrology and Antenatal care clinics. Local examination included morphology of skin changes (monomorphic or polymorphic), type of lesion (primary or secondary), distribution of skin disease (localized or generalized, unilateral or bilateral) and site of the lesion. Results: The most common physiological skin changes were pigmentary changes (98%) followed by striae distensae (76%), vascular changes (27.3%), hair changes (20.2%), glandular changes (19%) and nail changes (2%). As regarding pigmentary changes; lineanigra (86.6%), secondary areola (74.3%) and melasma (44%) were most common pigmentary changes in pregnant women.Scabies was the most common associated dermatological disorder (2.7%) of pregnant women followed by acute urticaria (1.3%), polymorphic light eruption (1.3%) and molluscum contagiosum (0.3%) of patients.Pregnancy-induced dermatoses were found in 67 (11.3%) of pregnant women. Atopic eruption of pregnancy (44.8%) was the most common condition [i.e. includes eczema (23.9%), prurigo (14.9%) and pruritis folliculitis (6%)]; polymorphic eruptions (44.8%), intrahepatic cholestasis of pregnancy (6%) and pemphigoid gestationis (4.5%) of pregnant women. Conclusion: Pregnancy is a unique physio-logical state characterized by metabolic, immunologic, and hormonal readjustments. These make a pregnant woman vulnerable to all dermatoses occurring in the non-pregnant state and also to certain eruptions related to the physiologic burden of gestation.

Skin Changes during Pregnancy: A Study from Northeast India.

Skin Changes during Pregnancy: A Study from Northeast India.

Specific dermatoses of pregnancy

The specific dermatoses of pregnancy represent aheterogeneous group of inflammatory skin diseases related to pregnancy and/or the postpartum period. Aclinically relevant classification has been well established over the past 10years and includes pemphigoid gestationis, polymorphic eruption of pregnancy, intrahepatic cholestasis of pregnancy, and atopic eruption of pregnancy. The hallmark of all four entities is severe pruritus that is accompanied by characteristic skin changes. While some of these dermatoses are distressing only to the mother because of pruritus, others may be associated with significant fetal risks. Early diagnosis and prompt treatment are therefore essential. In this review, we discuss in detail pemphigoid gestationis, polymorphic and atopic eruptions of pregnancy whereas intrahepatic cholestasis of pregnancy is discussed in aseparate article (Kremer A, Ständer S, DOI 10.1007/s00105-016-3923-y ). Furthermore, we present ahelpful algorithm for diagnosis and management of pruritus in pregnancy.

한방치료로 호전된 임신성 아토피 발진환자의 치험례

Objectives: The purpose of this study is to report the effect of Korean medical treatment on a patient with atopic eruption of pregnancyMethods: Patient who diagnosed by atopic eruption of pregnancy was enrolled in this study. She received Korean medicine therapies such as herbal medicine, acupuncture and external application. Sopungchungyoung-tangs and Seungmahwangryeon-tangs were prescribed according to the patient’s constitution which was pungyeol. The severity of symptom was evaluated by the severity SCORing for Atopic Dermatitis index (SCORAD index).Results: Subjective symptom such as Systemic pruritus, sleep loss, and Dermatitis lesions was reduced by Korean medicine therapies.Conclusions: The present study suggests that Korean medicine therapies have a effect on atopic eruption of pregnancy.

Prurigo, pruritic folliculitis, and atopic eruption of pregnancy: Facts and controversies

Prurigo (PP) and pruritic folliculitis of pregnancy (PFP) are poorly characterized entities. Traditionally classified under specific dermatoses of pregnancy, they were reclassified under a new umbrella entity, atopic eruption of pregnancy (AEP), which also includes atopic dermatitis (AD) that can worsen or present for the first time in pregnancy. Still, several aspects of AEP have not been adequately elucidated. It needs to be clarified whether it is the intrinsic (“nonallergic” or “atopiform dermatitis”) or extrinsic (immunoglobulin E–associated) AD that is affected by pregnancy. Future studies need to examine the postpartum prognosis of AD that develops for the first time during gestation. A revision of diagnostic criteria of AEP will allow a more accurate estimate of its prevalence, as well as clarification of the relationship between AD and specific dermatoses, such as PP and PFP. In this context, this review discusses the history, epidemiologic data, clinicopathologic features, and management of these entities.

Inflammatory and glandular skin disease in pregnancy

A switch from cell-mediated to humoral immunity (helper T 1 [Th1] to helper T 2 [Th2] shift) during gestation plays a key role in placental immune tolerance. As a result, skin diseases that are Th2 mediated often worsen, whereas skin diseases that are Th1 mediated often improve during gestation. Also, due to fluctuations in glandular activity, skin diseases involving sebaceous and eccrine glands may flare, whereas those involving apocrine glands may improve during pregnancy. Despite these trends, inflammatory and glandular skin diseases do not always follow the predicted pattern, and courses are often diverse. We review the gestational course of inflammatory skin diseases, such as atopic dermatitis (atopic eruption of pregnancy), psoriasis, impetigo herpetiformis, urticaria, erythema annulare centrifugum, pityriasis rosea, sarcoidosis, Sweet syndrome, and erythema nodosum, as well as glandular skin diseases, including acne vulgaris, acne rosacea, perioral dermatitis, hidradenitis suppurativa, Fox-Fordyce disease, hyperhidrosis, and miliaria. For each of these diseases, we discuss the pathogenesis, clinical presentation, and management with special consideration for maternal and fetal safety.

Dermatoses of pregnancy: Nomenclature, misnomers, and myths

The most recent reclassification of dermatoses of pregnancy includes polymorphic eruption of pregnancy, atopic eruption of pregnancy, and pemphigoid gestationis; intrahepatic cholestasis of pregnancy, strictly not a dermatosis, was included in specific dermatoses of pregnancy for working purposes. Another dermatosis, pustular psoriasis of pregnancy, could be included for similar reasons. The nomenclature of these pregnancy-specific eruptions has been revised several times, generating potential confusion among practitioners. Clouding the picture further are misnomers that have been used to describe dermatoses of pregnancy. In addition, several cutaneous conditions that are associated with, but not specific to, pregnancy, have been misunderstood, which has resulted in certain myths among patients and physicians. In this contribution, we describe how the nomenclature of each dermatosis of pregnancy has evolved to fit the current classification scheme. We then identify several misnomers that have generated confusion within the scheme. Finally, we debunk several myths that have developed around cutaneous conditions outside of this scheme, in both mother and newborn.

Study of Cutaneous manifestation of pregnancy in a Tertiary Care Hospital, South India

Background: Pregnancy is a period of profound immunologic, endocrine, metabolic and vascular changes, which makes them venerable for physiological and pathological changes in skin and its appendages. Dermatoses unique to pregnancy are important to recognize for the clinician as they carry considerable morbidity for pregnant mothers and in some instances constitute a risk to the fetus. Objectives: To determine the frequency and pattern of dermatoses in pregnancy. Methods: A total of 600 pregnant women attending out- patient department of dermatology and obstetrics at tertiary care hospital having symptoms related to skin, nail and its appendages between June 2014 and July 2015 were studied. Detailed history, clinical examination and relevant investigations were performed. The data was analyzed by using SPSS software version 16. Results: Age of patients ranged from 18 years to 44 years. Primigravida group accounted for about 396 (66%). Commonest physiological changes noted was Striae distensae 288 (48%) followed by Linea nigra 270 (45%), Gingival hyperemia/ gingivitis was seen 20 (3.33%), Pigmentary changes 198 (33%), Melasma 192 (32%). Polymorphic eruption of pregnancy (PEP) 31 (5.6%) was the commonest specific dermatosis followed by Atopic eruption of pregnancy (AEP) 12(2%) Pemphigoid Gestations (PG) 1 (0.16%) and Intrahepatic Cholestasis Pregnancy (ICP) 1 (0.16%) Fungal infection 40 (6.6%) was the commonest infection, followed by bacterial infections 12(2%). 4 patients showed skin scraping positive for Scabies mite. Conclusion: Physiological dematoses are common in Primigravida compared to multigravida. Specific dermatoses of pregnancy are also not uncommon, can be a source of significant distress to the patients which warrants specific care in turn influences the maternal and fetal outcome. The awareness, recognition of these skin conditions, familiarity with their treatment, antepartum surveillance, early diagnosis and prompt treatment is essential for improv

“One year clinical study of dermatoses in pregnancy”

Objectives: To study frequency and pattern of physiological skin changes and skin disease effected by pregnancy and factors affecting them. Methods: A total of 300 pregnant women were randomly selected from outpatient antenatal clinic and antenatal ward in ASRAM, Eluru appropriate investigations were done to confirm the diagnosis if required. Results: Majority of the pregnant women were multipara, belonging to age group 21-25 years and most changes were observed in the third trimester of pregnancy. Pigmentation was the commonest physiological change. Striae were more common in multigravida, more on abdomen but the onset of striae was early on breast. Among specific dermatoses, atopic eruption of pregnancy was observed to be the most common. Infections and infestations constituted a major part of affected dermatoses. Conclusions: In this study various pregnancy dermatoses were studied. It is imperative to recognize these changes to differentiate benign conditions from those associated with potential fetal and maternal risks and to know when the treatment should be initiated. Keywords: Pregnancy, physiological changes, specific dermatoses

Dermatological Diseases Associated with Pregnancy: Pemphigoid Gestationis, Polymorphic Eruption of Pregnancy, Intrahepatic Cholestasis of Pregnancy, and Atopic Eruption of Pregnancy.

Dermatoses unique to pregnancy are important to recognize for the clinician as they carry considerable morbidity for pregnant mothers and in some instances constitute a risk to the fetus. These diseases include pemphigoid gestationis, polymorphic eruption of pregnancy, intrahepatic cholestasis of pregnancy, and atopic eruption of pregnancy. This review discusses the pathogenesis, clinical importance, and management of the dermatoses of pregnancy.

Histopathological diagnosis of atopic eruption of pregnancy and polymorphic eruption of pregnancy: a study on 41 cases.

The specific dermatoses of pregnancy represent a recently reclassified heterogeneous group of pruritic inflammatory skin diseases unique to pregnancy that include pemphigoid gestationis, polymorphic eruption of pregnancy (PEP), intrahepatic cholestasis of pregnancy, and atopic eruption of pregnancy (AEP). Among them, PEP and AEP are the most frequent ones. We performed a histopathological study of a series of PEP and AEP patients (n = 41). Twenty-two patients had PEP that started in the third trimester in 16 (73%) patients and postpartum in 6 (27%) patients. Histopathology revealed a superficial or superficial and deep perivascular dermatitis with eosinophils in all biopsies and signs of a lymphocytic vasculitis in 5 (23%) cases. Epidermal changes, including epidermal hyperplasia, spongiosis, and parakeratosis, occurred in 8 cases, in particular in elder lesions. Nineteen patients had AEP that started earlier [less than third trimester, 14 (74%) patients; third trimester, 5 (26%) patients]. Clinically, 5 (26%) patients showed eczematous lesions, 7 (37%) papular lesions, 3 (16%) presented both eczematous and prurigo lesions, and 4 (21%) experienced exacerbation of preexisting atopic dermatitis. Histopathologically, AEP was characterized by a perivascular lymphohistiocytic infiltrate with frequent eosinophils (74%) and epidermal changes in all but most of P-type biopsies. No definitive differential histopathological criteria between PEP and AEP were found. Only lymphocytic vasculitis with a mixed infiltrate with eosinophils was more frequent in PEP patients. Timing of onset, morphology of skin lesions, and a detailed clinicopathologic correlation are essential for diagnosis.

Dermatoses Específicas da Gravidez

During pregnancy immunological, metabolic, hormonal and vascular changes occur, and can cause specific skin diseases. The specific dermatoses of pregnancy have undergone numerous changes in nomenclature and classification, partly due to advances in the knowledge of the pathogenesis of these skin diseases. Currently the following diseases are considered specific dermatoses of pregnancy: pemphigoid gestations, polymorphic eruption of pregnancy, intrahepatic cholestasis of pregnancy and atopic eruption of pregnancy. Timely diagnosis and specific and safe treatment are essential to prevent complications which, although rare, may be associated with significant maternal-fetal comorbidity.

Skin eruptions specific to pregnancy: an overview

Key content Pregnancy results in various physiological skin changes. As a consequence, some common dermatoses can present more frequently in pregnant women. In addition, there are a number of skin eruptions unique to pregnancy. The aetiology of physiological skin changes in pregnancy is uncertain but is thought to be due to hormonal and physical changes of pregnancy. The four dermatoses of pregnancy are: atopic eruption of pregnancy, pemphigoid gestationis, polymorphic eruption of pregnancy and intrahepatic cholestasis of pregnancy. Learning objectives To understand the physiological skin changes in pregnancy. To identify the skin conditions that require appropriate referral. To be able to take a history, to diagnose the skin eruptions unique to pregnancy, undertake appropriate investigations and first‐line management, and understand the criteria for referral to a dermatologist.

Specific dermatoses of pregnancy and their treatment

The specific dermatoses of pregnancy represent a diverse group of intensely pruritic dermatoses, occurring only in the puerperal state. The relative rarity of these conditions, the often variable clinical appearance, and the lack of definitive diagnostic tests have led to confusion regarding the appropriate diagnosis and management of the specific dermatoses of pregnancy. Herein we review the clinical characteristics, diagnosis and treatment of five dermatoses occurring during pregnancy: pruritic urticarial papules and plaques of pregnancy, atopic eruption of pregnancy, pemphigoid gestationis, intrahepatic cholestasis of pregnancy, and pustular psoriasis of pregnancy.

Female-specific pruritus from childhood to postmenopause: clinical features, hormonal factors, and treatment considerations

There have been considerable advances in our understanding of the pathophysiology of pruritus in recent years. The purpose of this review was to highlight itch entities in women, and in particular pruritic vulvar dermatoses that women experience among different age groups. Unique temporal shifts may contribute to the etiology of many of these conditions. These changes lead to cyclical changes in the skin's basic composition. Specifically, estrogen receptors have been detected on keratinocytes that respond to rising and falling levels of estrogen. These receptors lead to changes in skin hydration, collagen content, and in the concentration of glycosaminoglycans that form the skin barrier. In addition, hormonal pH changes associated with the menstrual cycle may be an important factor in the aggravation of itch as increasing pH is known to activate the proteinase-activated receptor-2, a well-known itch mediator. Common pruritic conditions in women that will be discussed include atopic and irritant dermatitis, psoriasis, lichen sclerosus, infectious vulvovaginitis, vulvovaginal candidiasis, atrophic vulvovaginitis, squamous cell carcinoma, lichen simplex chronicus, and neuropathic itch. We also examine pruritic conditions associated with pregnancy including pemphigoid gestationis, polymorphic eruption of pregnancy, intrahepatic cholestasis of pregnancy and atopic eruption of pregnancy. Finally, acceptable and contraindicated antipruritic agents in pregnancy are examined.

Recent developments in the specific dermatoses of pregnancy

During pregnancy, the mother undergoes changes to sustain and enable normal growth and development of the fetus. Common physiological changes include linea nigra, fibroepithelial polyps, striae, spider angioma, palmar erythema and pruritis gravidarum. However, there are some changes that are purely pathological, and these are termed the pregnancy-specific dermatoses (PSDs). The PSDs occur during pregnancy or in the immediate postpartum period. They do not include the various benign conditions or pre-existing dermatoses and tumours that may present or worsen with pregnancy. They do include a number of distinct and identifiable conditions: atopic eruption of pregnancy (AEP), polymorphic eruption of pregnancy (PEP), intrahepatic cholestasis of pregnancy (ICP) and pemphigoid gestationis (PG). These are a heterogeneous group of skin conditions characterized by pruritis and inflammatory changes. In addition, pruritis gravidarum is sometimes considered pathophysiological and thus part of this group, rather than a physiological process. Each of these conditions has a distinct, but not fully understood, pathogenesis. The mechanisms leading to PSD may be a reflection on the hormonal and immunological changes associated with pregnancy. AEP and PEP are benign conditions, and although they can cause distress to the mother, they are otherwise minor. However, ICP and PG are more serious conditions, and both carry the potential for serious risks to both the mother and the fetus. Thus, the pathophysiology of these latter two conditions is considered in more detail in the following article.

Pregnancy Dermatoses

Some aspects regarding the etiology and the nosologic classification of various pregnancy dermatoses are highly controversial. While some authors highlight the existence of premises allowing several skin disorders to be re-grouped within broader disease concepts, others underline the absence of clear, undisputed etiopathogenetic data that could support such classifications. This review exhaustively analyzes the various pregnancy dermatoses (pemphigoid gestationis, intrahepatic cholestasis of pregnancy, impetigo herpetiformis, polymorphic eruption of pregnancy, and the papular dermatoses of pregnancy [prurigo of pregnancy, pruritic folliculitis of pregnancy, and the new classification, atopic eruption of pregnancy]) in an attempt to shed light over this confusing and disputed domain, while subsequently offering an algorithmic approach to their diagnosis and management. While for pemphigus gestationis, intrahepatic cholestasis of pregnancy, and impetigo herpetiformis, specific diagnostic tests such as histopathology, immunofluorescence, or laboratory investigations will confirm the diagnosis, the identification of the other types of pregnancy dermatoses is based only on clinical criteria. In this context, the review argues for the inclusion of the whole group represented by the papular dermatoses of pregnancy within the broad spectrum of polymorphic eruption of pregnancy, separating each of these entities by focusing on their onset: early-onset polymorphic eruption of pregnancy (comprising prurigo of pregnancy, pruritic folliculitis of pregnancy, and atopic eruption of pregnancy) and late-onset polymorphic eruption of pregnancy. In light of the same practical approach guiding it, the review provides updated treatment strategies for each of these conditions.

Dermatoses of Pregnancy - Clues to Diagnosis, Fetal Risk and Therapy

The specific dermatoses of pregnancy represent a heterogeneous group of pruritic skin diseases that have been recently reclassified and include pemphigoid (herpes) gestationis, polymorphic eruption of pregnancy (syn. pruritic urticarial papules and plaques of pregnancy), intrahepatic cholestasis of pregnancy, and atopic eruption of pregnancy. They are associated with severe pruritus that should never be neglected in pregnancy but always lead to an exact work-up of the patient. Clinical characteristics, in particular timing of onset, morphology and localization of skin lesions are crucial for diagnosis which, in case of pemphigoid gestationis and intrahepatic cholestasis of pregnancy, will be confirmed by specific immunofluorescence and laboratory findings. While polymorphic and atopic eruptions of pregnancy are distressing only to the mother because of pruritus, pemphigoid gestationis may be associated with prematurity and small-for-date babies and intrahepatic cholestasis of pregnancy poses an increased risk for fetal distress, prematurity, and stillbirth. Corticosteroids and antihistamines control pemphigoid gestationis, polymorphic and atopic eruptions of pregnancy; intrahepatic cholestasis of pregnancy, in contrast, should be treated with ursodeoxycholic acid. This review will focus on the new classification of pregnancy dermatoses, discuss them in detail, and present a practical algorithm to facilitate the management of the pregnant patient with skin lesions.

Specific dermatoses of pregnancy: advances and controversies

Specific dermatoses of pregnancy include herpes (pemphigoid) gestationis, polymorphic eruption of pregnancy (also known as pruritic urticarial papules and plaques of pregnancy), prurigo of pregnancy and pruritic folliculitis of pregnancy. This article focuses on what is currently known about the epidemiology, clinical characteristics, etiopathogenesis and management of these disorders. Moreover, it discusses the intrahepatic cholestasis of pregnancy and ‘atopic eruption of pregnancy’, which were recently reclassified as specific dermatoses of pregnancy, as well as debates related to the prevalence and diagnostic criteria of the latter. Finally, it addresses the suggested overlap between ‘atopic eruption of pregnancy’ and specific dermatoses of pregnancy, such as prurigo and pruritic folliculitis.

Spezifische Schwangerschaftsdermatosen

The specific dermatoses of pregnancy represent a heterogeneous group of inflammatory skin diseases related to pregnancy and/or the postpartum period. The most recent classification includes pemphigoid gestationis, polymorphic eruption of pregnancy, intrahepatic cholestasis of pregnancy, and atopic eruption of pregnancy. The hallmark of all four entities is severe pruritus that is accompanied by characteristic skin changes. While some of these dermatoses are distressing only to the mother because of pruritus, others may be associated with significant fetal risks. Early diagnosis and prompt treatment are therefore essential. In this review, we will discuss the various pregnancy dermatoses in detail and present an algorithm for diagnosis and management of pruritus in pregnancy.