Prurigo of Pregnancy

162

16.1
Definition

Prurigo of pregnancy (PP) is a relatively common benign skin disease characterized by

pruritic papules primarily on the extensor aspects of the extremities. Prognosis for mother
and fetus is excellent.

16.2
Introduction

The term “prurigo gestationis” was first introduced by Besnier et al. [4] in 1904 to include all
patients with a pregnancy rash, other than herpes gestationis [1]. Later, Nurse [16], in 1968,
divided PP into two main groups: “early onset” and “late onset” PP; the latter group appar-
ently included cases of pruritic urticarial papules and plaques of pregnancy (PUPPP) [1].
Nowadays, “prurigo of pregnancy” is a term that encompasses Besnier’s prurigo ges-
tationis, Nurse’s early-onset form of prurigo, and Spangler’s papular dermatosis of preg-
nancy [19]. PP may be a distinct entity, may represent an unusual variant of PUPPP [8],
or may be a simplified labeling of a heterogeneous group, classified together because of
broad clinical overlap, incomplete evaluation, and the fact that the pathogenesis has not
been identified in any of them [14, 19]. It has been debated whether “linear IgM dermato-
sis of pregnancy” described by Alcalay et al. [2] should be classified as a distinct entity or
whether it may be a variant of PUPPP or PP [18, 19, 23]. In 2006, Ambros-Rudolph et al.
[3] proposed reclassifying PP as part of a newly defined disease complex, named “atopic
eruption of pregnancy.”

A. Ingber, Obstetric Dermatology, 151

DOI: 10.1007/978-3-540-88399-9, © Springer-Verlag Berlin Heidelberg 2009
 152 16 Prurigo of Pregnancy

16 16.3
Incidence

PP is a relatively common skin disorder during pregnancy [11]. Its incidence varies between
one in 300 pregnancies and one in 450 pregnancies [16, 17], and it may account for up to 6%
of pregnancy-associated dermatoses [22]. It is probably more common in women with atopic
dermatitis, where the severe pruritus results in the development of prurigo lesions [1].

16.4
Clinical Presentation

PP has been reported in all trimesters of pregnancies, but it typically presents during the second
or the third trimester, most commonly in the 25th to the 30th week of pregnancy [8, 14, 19].
PP is characterized by small groups of discrete, erythematous or skin-colored papules
and nodules, which are extremely itchy, resulting in excoriated lesions. They develop pri-
marily on the extensor surfaces of the arms and legs and on the dorsal aspects of the hands
and feet, and occasionally on the abdomen (Figs. 16.1–16.4) [1, 6, 8, 11, 14]. In some cases
the lesions may spread to the chest and back [5].

Fig. 16.1 Areas of involvement of prurigo of Fig. 16.2 Areas of involvement of prurigo of
pregnancy, anterior view pregnancy, posterior view