Dermatoses of Pregnancy: Key Points and Clinical Pearls

Ted Rosen, MD

1. There are physiologic cutaneous changes associated with pregnancy. These include: linea nigra, melisma, striae, faster growing and harder nails, faster growing hair (followed by telogen effluvium 3 months or so post-partum).

2. Treatments for the physiologic changes of pregnancy rarely work well.

  • Melasma: Combination of retinoid, hydroquinone, glycolic acid peels
  • Striae: Perhaps Fraxel laser or Needling device

3. The immune system changes during pregnancy

  • TH1 cell-mediated immunity decreases: EGW may worsen
  1. Imiquimod appears safe
  2. Thermotherapy is safe
  3. Cryotherapy is safe
  4. CO2 laser is treatment of choice
  • TH2 humoral immunity increases: Lupus may worsen or appear for first time

4. Specific dermatoses of pregnancy have been consolidated into just a few entities:

5. Intrahepatic cholestasis of pregnancy

  • Risk to mother: None (itches)
  • Risk to fetus: Stillbirth, Premature birth, intra-cranial hemorrhage
  • Therapy: Oral ursodeoxycholic acid 15mg/kg/day in QID divided doses

6. Herpes (Pemphigoid) Gestationis

  • Risk to mother: Autoimmune disorders: vitiligo, Grave’s disease, alopecia areata, IBD
  • Risk to fetus: Small for gestational age, premature delivery, blisters (10%)
  • Therapy: Systemic steroids

7. Pruritic Urticarial Papules & Plaques of Pregnancy (PUPPP)

  • Risk to mother: None (itches severely)
  • Risk to fetus: None
  • Therapy: Topical steroids, UVB (sunlight)

8. Prurigo of Pregnancy (PP)

  • Risk to mother: None
  • Risk to fetus: None
  • Therapy: Topical steroids

9. Impetigo herpetiformis (Now considered pustular psoriasis of pregnancy)

  • Risk to mother: Electrolyte abnormalities, especially calcium homeostasis
  • Risk to fetus: Spontaneous abortion, Stillbirth
  • Therapy: Systemic steroids or cyclosporine

10. Excellent review: Dermatol Ther 26:274-84, 2013