Frequency and clinical variants of specific dermatoses in third trimester of pregnancy: a study from a tertiary care centre.

OBJECTIVE: To determine the frequency of patients with dermatoses in the third trimester of pregnancy and to identify various clinical types of dermatoses in the third trimester. METHODS: The study was carried out at the Department of Dermatology and the Department of Gynaecology & Obstetrics, PNS Shifa Hospital, Karachi, from January 2 to July 1, 2008. Two hundred pregnant women in their third trimester were included in the study. The diagnosis was based on history, clinical examination and relevant investigations. Patients with physiological dermatoses and dermatoses which flare up during pregnancy were excluded. A comprehensive pro-forma was used to evaluate different dermatoses. Skin biopsy for histopathology was also done where necessary. RESULTS: The age of the study population ranged from 17 to 36 years (mean = 27.3 +/- 4.86). Five (2.5%) patients had prurigo of pregnancy, 4 (2%) had dermatoses associated with Intrahepatic Cholestasis of Pregnancy (ICP), 3 (1.5%) patients had polymorphic eruption of pregnancy, and 1 (0.5%) patient had pruritic folliculitis of pregnancy. No case of pemphigoidgestationis was observed. CONCLUSION: In the study, 6.5% patients presented with specific dermatoses. Prurigo of pregnancy was the commonest condition. Polymorphic eruption of pregnancy was more common in primigravida, while dermatoses with intrahepatic cholestasis was seen more often in multigravida.

Infiltrated leishmaniasis recidivans cutis on the face: a rare clinical presentation.

Cutaneous leishmaniasis is a protozoan disease caused by Leishmania and transmitted by the bite of some species of sand flies. Usually it presents with variety of clinical manifestations depending on both the infecting species of Leishmania and the immune response of the host. Leishmaniasis recidivans cutis (LRC) is a unique form of cutaneous leishmaniasis characterized by unusual clinical features and its chronic relapsing nature. It is an evolving form of cutaneous leishmaniasis which clinically presents as a spreading of the initial nodule, leading to a plaque formation simulating discoid lupus erythematosus. A clinical course of leishmania recidivans is probably related to changes in cell-mediated immunity leading to localized or diffuse lesions. We report a case that presented with infiltrated, atrophic plaque on a patient's face. Clinically, the lesion resembled the lesion of discoid lupus erythematosus and lupus vulgaris but the cutaneous biopsy proved the diagnosis to be LRC.