ABSTRACT
The specific dermatoses of pregnancy represent a heterogeneous group of inflammatory skin diseases related to pregnancy and/or the postpartum period. A clinically relevant classification has been well established over the past 10 years 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 a separate article (Kremer A, Ständer S, DOI 10.1007/s00105-016-3923-y ). Furthermore, we present a helpful algorithm for diagnosis and management of pruritus in pregnancy.
Subject(s)
Pregnancy Complications/diagnosis , Pregnancy Complications/therapy , Skin Diseases/diagnosis , Skin Diseases/therapy , Algorithms , Cholestasis, Intrahepatic/diagnosis , Cholestasis, Intrahepatic/therapy , Dermatitis, Atopic/diagnosis , Dermatitis, Atopic/therapy , Evidence-Based Medicine , Female , Humans , Pemphigoid Gestationis/diagnostic imaging , Pemphigoid Gestationis/therapy , Pregnancy , Pruritus/diagnosis , Pruritus/therapy , Treatment OutcomeABSTRACT
BACKGROUND: Pemphigoid gestationis is a rare autoimmune disorder of pregnancy characterized clinically by a pruritic, papular rash and in some cases intrauterine growth restriction and premature delivery. The growth disorder is secondary to antibody deposition in the placental bed, with resultant placental insufficiency. The appropriate fetal assessment required during these gestations remains uncertain. The use of serial Doppler velocimetry of the umbilical arteries has not been reported to date in this disorder. CASE: A woman had pemphigoid and progressively decreasing umbilical artery end-diastolic flow over a period of weeks without documented fetal growth restriction. Delivery was finally prompted by reversal of end-diastolic flow. CONCLUSION: We suggest that parturients with this condition undergo frequent umbilical artery Doppler studies to document end-diastolic velocity even without the ultrasound finding of intrauterine growth restriction.
