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Pregnancy related skin changes and skin

disease
Hassan T, Mohsena M, Sultana A,
Khondoker L, Islam S, Sultana R

Pembimbing : dr. Romuan Roger Sp.KK

Dibuat Oleh : Nella ( 11.2011.284 )
Kepaniteraan Klinik Ilmu Kulit dan Kelamin
Fakultas Kedokteran UKRIDA
RSUD KOJA

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Abstrak

The skin and related structures

undergo changes during pregnancy
and peurperium

They can be separated into three

categories

hormone related pregnancy specific

and preexisting
The physiologic changes are mainly
of cosmetic importance.
The pregnancy specific skin
diseases have associated symptoms
Most skin conditions resolve post
partum and only require
symptomatic treatment

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SLI

Introduction
1. Pregnancy is a state
of profound hormonal,
immunologic and
metabolic changes
2. These changes
contribute to the
spectrum of
physiologic changes
seen in pregnancy

Normal hormonal changes during

pregnancy may cause benign skin
conditions

Pigmentary

Vascular

Structural and appendageal changes.

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Introduction
Pregnancy specific skin conditions

cholestasis of pregnancy
and impetigo
herpetiformis

pemphigoid
gestationis

prurigo of pregnancy
and pruritic folliculitis

pruritic urticarial papules

and plaques of pregnancy

fungal infection and

cutaneous tumours

skin conditions like

atopic dermatitis and
psoriasis

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Physiologic cutaneous changes in pregnancy

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Pigmentary changes
1. Hyperpigmentation (90%)
2. The increase in melanocyte stimulating hormone,
estrogen and progesterone Linea nigra
3. Melasma (50% to 70%)
4. Treatment consists of sunscreen, hydroquinone
and tretinoin

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Physiologic cutaneous changes in pregnancy

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Structural Changes
1. Striae gravidarum or stretch marks
2. Stress in connective tissue and increased
glucocorticiod levels due to elevated
adrenocortical activity
3. Treatment : dietary supplements, topical low dose
tretinoin or laser therapy with flashlamppumped
pulsed dye laser post-pregnancy

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Physiologic cutaneous changes in pregnancy

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Molluscum fibrosum gravidarum

1. Benign, pedunculated, tan to brown, fleshy
papules similr to acrochordons that are commonly
seen on the neck, axilla, inner thighs and
inframammary folds.
2. Treatment options include shave excision,
electrocautery and scissors removal.

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Physiologic cutaneous changes in pregnancy

Vascular changes
1. Human chorionic gonadotrophin,
2. Adrenocorticotrophic hormone
3. Thyrotrophin releasing hormone and estrogen

Increase in cardiac output, vascular proliferation,

congestion and vasomotor instability.

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Physiologic cutaneous changes in pregnancy

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Spider nevi or angiomas

1. Face, neck and arms commonly during the 1st
and 2nd trimesters
2. Most spider nevi regress post partum but a small
percentage persist and require treatment with
elrctrocautery or laser.

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Palmer erythema
1. A mottled erythema of the thenar and hypothenar
eminences
2. 2/3 of light-complected and 1/3 of dark complected
3. Indicating a possible role of increased estrogen
levels as a common cause

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Physiologic cutaneous changes in pregnancy

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Varicosities
Increased distension in the superficial venous
vasculature
Legs (varicose veins)
Vagina
Vestibule (jaccquemier-chadwick sign)
Rectum (haemirrhoids)

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Physiologic cutaneous changes in pregnancy

Vascular changes coupled with
increased blood volume
Cause increased leakage which leads to non
pitting edema of the face, eyelids and
extremities up to one half of pregnant woman.

Vasomotor instability

Facial flushing
Dermographism
Hot and cold sensation and marble skin
A condition characterized by bluish skin
discoloration from an exaggerated response
to cold Spider-like telangiectasias require
sclerotherapy or laser therapy.

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Physiologic cutaneous changes in pregnancy

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Granuloma
gravidarum

a benign, rapidly proliferating vascular lesion

that commonly occurs at previous sites of
trauma on the face, neck and digits

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Physiologic cutaneous changes in pregnancy

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Appendageal changes
1. Activity of eccrine glands along with increased
thyroid activity results in hyperhidrosis and miliaria.
2. Decrease in activity of apocrine gland and improvement
of conditions such as hidradenitis suppurativa.
3. Sebaceous gland demonstrate increased activity during
pregnancy resulting in new onset or exacerbation of
preexisting acne

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Physiologic cutaneous changes in pregnancy

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Hair and nail

changes

1. Decrease in the percentage of hair follicle in

telogen phase
2. Increased thickness of body and scalp hair
3. Hirsutism
4. Nails usually grow faster
5. Nail changes such as onycholysis, transverse
grooving, brittleness and subungual
keratosis

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Preexisting skin conditions

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Pregnancy specific dermatologic disorder

SLIDE 16
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Pemphigoid
gestationis

- an autoimmune skin disorder

- 1 : 50.000
- Clinical presentation is an abrupt onset of an
intensely priritic urticarial eruption on the
trunk that forms tense vesicobullous lesions

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Pregnancy specific dermatologic disorder

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Impetigo
Herpetiformis

1. The disease begins as erythematous plaques with

pustules on the inner thighs, flexural areas and groin.
The lesions spread to the trunk and extremities.
2. As the plaques enlarge, the centre becomes eroded
and crusted. The hands, feet and face are usually
spared. Oral and esophageal erosion can occur. Pruritus
is mild but lesions are painful and flu-like symptoms
are often present

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Pregnancy specific dermatologic disorder

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Cholestasis of pregnancy
1. Clinical presentation includes severe generalized
pruritus with no primary skin lesions with or without
jaundice.
2. Secondary excoriations due to patients scratching
may be the only skin findings. The extent and
severity of pruritus fluctuates until the time of
delivery.34 Most severe pruritus occurs at night

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Pregnancy specific dermatologic disorder

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Pruritic urticarial papules and plaques of
pregnancy (PUPPP)
1. 1: 160
2. 75% - 80% primigravida
3. The eruption begins on the abdomen along striae
distensi sparing the umbilical and peri umbilical
area
4. The lesions include vesicular, target-like, annular,
polycyclic papules or plaques that become
confluent over time.
5. Topical corticosteroids of low to mid potency and
pregnancy category B antihistamines such as
loratidine and cetirizine

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Pregnancy specific dermatologic disorder

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Prurigo of Pregnancy
1. 2nd and 3nd semester of pregnancy as discrete
erythematous papules with excoriations
2. The lesions typically present on the extensor
surfaces of arms and legs or on the abdomen
3. Skin biopsy shows parakeratosis and mild
acanthosis with a mixed inflammatory infiltrate
of neutrophils and eosinophils in the perivascular
area
4. Topical corticosteroids and antihistamines

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Pregnancy specific dermatologic disorder

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Papular Dermatitis of Pregnancy

1. A generalized papular erythematous and
pruritic eruption with central crust.
2. The distribution is on the abdomen with
spread to the extremities
3. The high fetal risk initially reported by
Spangler has

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Pregnancy specific dermatologic disorder

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Pruritic Folliculitis of Pregnancy

1. Onset of eruption commonly occurs in the
2nd or 3nd trimester of pregnancy as
small erythematous papules around
follicles.
2. The lesions begin on the abdomen and
spread to the extremities
3. The fetus is unaffected and spontaneous
resolution occurs after delivery.
4. Treatment options are low to mid potency
topical steroid or topical benzoyl peroxide

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