妊娠期皮膚病

1、妊娠期皮膚病Physiologic skin changes in pregnancyDermatoses exacerbated by pregnancyDermatoses only occurring in pregnancySpecific dermatoses of pregnancy2020/11/42Physiologic skin changes in pregnancy妊娠期皮膚的生理變化2020/11/432020/11/44Hyperpigmentation 色素沉著Occurs in 90% of pregnant womenIncreased melanocyte-s

2、timulating hormoneAccentuation on areolae, genital skin, and linea albaUsually regresses postpartum2020/11/45Melasma 黃褐斑Occurs in 70% of pregnant womenAlso seen with oral contraceptivetherapyCentrofacial, malar, and mandibular patternsExcessive melanin in epidermis or dermal macrophagesWorsens with

3、UVB exposure2020/11/46Hirsutism 多毛癥Face, limbs, and backRegresses within 6 months postpartumSlowed conversion from anagen to telogen hairs2020/11/47Nail changes 甲改變 Transverse grooving Brittleness Distal onycholysis2020/11/48Increased eccrine gland activity 內分泌腺活性增加MiliariaDyshidrotic eczemaHyperhid

4、rosis2020/11/49Decreased apocrine gland activity大汗腺活動性減少Hidradenitis suppurativa alleviated2020/11/410Increased sebaceous gland activity 皮脂腺活動性增加Exacerbation of acne vulgarisMontgomerys tubercles enlarge2020/11/411Striae distensae妊娠紋Occur in 90% of pregnant womenPink or purple atrophic longitudinal

5、bandsCaused by increased adrenocortical activityFade postpartum to persistent pale atrophic bands2020/11/412Vascular changes血管變化Spider neviPalmar erythemaNonpitting facial edemaVenous varicosities: LegsVasomotor instabilityDermographismEdema and hyperemia of gingivae2020/11/413Dermatoses exacerbated

6、 by pregnancy妊娠期加重的皮膚病2020/11/4142020/11/415Atopic eczema 特應性皮炎May deteriorate or remit during pregnancylimbs and/or trunk and faceMay present for the first time in pregnancy in predisposed personIrritant hand dermatitis and nipple eczema common postpartumTreatment: topical corticosteroids, emollien

7、ts, UVB2020/11/416Psoriasis 銀屑病Most common type : chronic plaque psoriasisDifferential diagnosis of pustular variant from impetigo herpetiformis may be difficultTopical treatment: Dithranol, calcipotriol, tar, and corticosteroids are all safe in pregnancySystemic drugs: retinoids, methotrexate, and

8、hydroxyurea are all contraindicated in pregnancy. Cyclosporine should be used with caution during pregnancy and breast-feeding.2020/11/417Acne vulgaris尋常痤瘡Urticaria蕁麻疹Lichen planus扁平苔蘚2020/11/418Infections 感染性皮膚病Viral (herpes simplex, varicella zoster)Bacterial (impetigo, trichomoniasis, leprosy)Fun

9、gal (candidal, Pityrosporum folliculitis)AIDS2020/11/419Lupus erythematosus (LE)Debate continues ：whether lupus flares are more common in pregnancy.Cutaneous flares are the most common, followed by arthritis.Painful vasculitic lesions on the peripheries are the most common skin lesions.Neonatal LE i

10、s seen in babies of mothers with circulating anti-Ro(SSA) antibodies and can lead to congenital heart block.The antiphospholipid syndrome presents with thrombosis, recurrent miscarriage, livedo reticularis, migraine, stroke, and/or thrombocytopenia.Treatment with systemic corticosteroids and antimal

11、arials should not be stopped in pregnancy, to prevent an acute flare.2020/11/420Systemic sclerosisPolymyositis/DermatomyositisPemphigus2020/11/421Cutaneous tumors affected by pregnancyPyogenic granulomaHemangiomaHemangioendotheliomaGlomus tumorDermatofibromaLeiomyomaKeloidNeurofibromaNeviMelanoma202

12、0/11/422Dermatoses only occurring in pregnancy僅發(fā)生在妊娠期的皮膚病2020/11/423Impetigo herpetiformis皰疹樣膿皰病Reminiscent of pustular psoriasis, no prior history of psoriasisAssociated with hypoparathyroidism and hypocalcemiaSystemic upset with malaise, fever, delirium, diarrhea, vomiting, and tetany secondary to

13、 hypocalcemiaErythematous patches with pustular margin in flexural distributionSparing of face, hands, and feetPostinflammatory hyperpigmentation commonHistopathologic features identical to pustular psoriasis with spongiform pustules of Kogoj, large collections of neutrophils within foci of spongiot

14、ic epidermisLaboratory findings: Elevated leukocyte count and erythrocyte sedimentation rate, hypocalcemiaTreatment: Prednisolone 30-40 mg dailyPrognosis: Stillbirth and placental insufficiency still frequently seen even when disease is apparently controlled. Remission postpartum but recurrence in s

15、uccessive pregnancies occurs frequently.2020/11/424Intrahepatic cholestasis of pregnancy妊娠期肝臟內膽汁郁積Increased incidence Presents in third trimester with severe intractable pruritus Clinical : Often only excoriations; clinical jaundice rare; mal-absorption of fat can lead to weight loss and vitamin K d

16、eficiency in severe casesUsually nonresponsive to antihistamines and topical emollientsHistopathologic findings: Skin findings nonspecific; liver biopsy specimen will reveal typical changes in severe cases with dilated bile canaliculi, staining of parenchyma with bile pigments and minimal inflammati

17、on. These changes are reversible postpartum.Pathophysiology: Associated with HLA subtype B8 and BW16 and positive family history in up to 50% of cases. Physiologic concentrations of estrogens thought to interfere with hepatic bile acid secretionAbnormal serum liver function tests (LFTs) and elevated

18、 serum bile acids confirm the diagnosis Treatment: Antipruritic emollients, Ion-exchange resins , UVB, evening primrose oil.Prognosis: Increased rate of fetal distress, stillbirth, and preterm delivery. 2020/11/425Specific dermatoses of pregnancy妊娠特異性皮膚病2020/11/426Pruritic urticarial papules and pla

19、ques of pregnancy (PUPPP)妊娠多形疹Incidence between 1 in 160 women and 1 in 300Presents in primiparous women in third trimester or postpartumIncreased incidence in multiple pregnancyRare recurrence in subsequent pregnancies Onset with pruritus within striae on abdomen; periumbilical sparing may occurCli

20、nically characterized by various lesions including erythematous plaques, papules, vesicles, purpura, and erythema multiformelike lesionsSubsequent spread to breasts, upper thighs, and arms, sparing faceSerologic and immunofluorescence tests negativeSubtype described in which IgM deposition seen eith

21、er on direct or indirect immunofluorescence Histopathologic characteristics: Spongiosis in epidermis with perivascular or upper dermal chronic inflammatory cell infiltratePathophysiology: Unknown, although several theories including the role of sex hormones and abdominal wall distension caused by pr

22、egnancy2020/11/4272020/11/4282020/11/429Prurigo of pregnancy妊娠癢疹Described by Besnier in 1904Incidence approximately 1 in 300Similar to nodular prurigo seen in nonpregnant personsLikely to be same eruption that Spangler described as papular dermatitis of pregnancyPruritic papules on extensor aspects

23、of limbs and on abdomenNormal maternal and fetal prognosisHistopathologic features: Chronic inflammatory cell infiltrate in upper dermis with occasional epidermal featuresPathophysiology: Unknown, although thought to be a result of physiologic pruritus in women with an atopic backgroundTreatment: Mo

24、derately potent topical corticosteroids, antihistaminesPrognosis: No adverse effects to mother or infant; resolution postpartum2020/11/430Herpes gestationis 妊娠皰疹Autoimmune bullous disorder, closely related to bullous pemphigoid (BP)Rare with incidence of approximately 1 in 60,000Onset usually in sec

25、ond and third trimester or postpartum periodRecurrence common in subsequent pregnancy at earlier gestation and with increased severity (apart from skip pregnancies, which occur when a woman with known PG has a subsequent unaffected pregnancy)Pruritic erythematous plaques, which become annular or pol

26、ycyclic, developing into vesicles or bullaePeriumbilical involvement in 87% of casesTransplacental transfer of antibodies can result in neonatal involvementAssociated with low birth weight and premature birth caused by placental insufficiencyHistopathologic features: Similar to PEP in early phases;

27、subepidermal separation with basal cell necrosis; eosinophilic spongiosisImmunofluorescence diagnostic test: Positive direct immunofluorescence with IgG and complement 3 staining at the basement membrane zone and staining to the roof on indirect immunofluorescence using salt-split skinPathophysiology: HLA-DR3, DR4 subtypes associated; close relationship to BP, sharing same target antigen BP-180 kd (BP-AG2), a component of hemidesmosomes; anti-HLA antibodies