妊娠皮膚病簡介

生理的變化

Enlarged of the intermediate lobe of the pituitary gland , the melanocyte-stimulating hormone (MSH) became remarkably elevated by 8 weeks gestation

常見的變化 -Hyperpigmentation

90% : skin darkening ; MSH and estrogen Beginning early in pregnancy and more pronounced in naturally hyperpigmented areas such as areolare , perineum and umbilicus and axillae and inner thigns, Linea nigra Face: cholasma or melasma ; 50% , sunscreens ; Regress postpartum , dermal melanosis persist up to 10 years in 1/3 pts2-5% hydroxquinone , 0.1% tretinoin gel or cream or 20% azelaic acid cream

cholasma or melasma 黑斑 or 肝斑

Linea nigra

常見的變化 -NaviPigmented cutaneous tumors commonly enlarge and darken during pregnancy , leading to their confusion with malignant melanomas.

6% changed in diameter over pregnancy

No evidence that they undergo malignant transformations

常見的變化 -Hair Growth

Growing hair phase is increased related to the resting hair phaseEstrogen prolong the growing hair phase and androgens cause enlargement of follicles Telogen effluvium: abrupt hair loss beginning 1 to 4 months postpartum ; self limited and restored in 6 to 12 months

常見的變化 -Vascular changeAugmented cutaenous blood flow: estrogen and decreased vascular resistanceSpider angiomas : 2/3 white and 1/10 black Palmar erythema : 2/3 white and 1/3 blackPapillary hemangiomas: 5% Pregnancy gingivitis (epulis): growth of the gum capillaries Pyogenic granuloma of pregnancy (granuloma gravidarum) : oral cavity and arise from the gingival papillae

Spider angiomas

Palmar erythema

Pregnancy gingivitis (epulis)

                                      

Pyogenic granuloma of pregnancy  

妊娠紋80 ～ 90﹪ 的孕婦懷孕 6 ～ 7 個月後開始產生，除了肚子之外，大腿、腹股溝甚至胸部都有可能出現粉紅或紫紅色萎縮性斑紋。除了荷爾蒙的影響，體重增加太快也是促成原因之一。雖然在產後會慢慢變白、變細，

但很多人是無法完全恢復的控制體重含果酸的乳液或其他可促進

彈力纖維生成的妊娠霜，來緊緻皮膚，預防妊娠紋產生。倘若妊娠紋已產生，在產後且妊娠紋尚未變白前，可接受脈衝光治療，有改善的機會。

                   

Dermatoses of pregnancy 1.6 % of women had significant pruritus at some time during prengancy Pruritus gravidarumPrurutuc ureticarial papules and plaques of pregnancyHerpes gestationis

Pruritus Gravidarum 0.6% pregnancy with pruritus : mild variant of intrahepatic cholestasis of pregnancy

Scratching and excoriation skin lesions

Hormone,genetics and enviornmental factors

Pruritic urticarial papules and plaques of pregnancy

PUPPP in US ; Polymorphic eruption of pregnancy (PEP) in UK 1/200 singleton , 8/200 for twin Pruritic cutaneous eruption that usually appears late in pregnancy ; abdomen firstly and then buttocks and thighs and extremities.40%: urticarial ; 45% erythematous pattern ; 15% combination; face spared and common in nulliparas and seldom recurs in subsequent pregnancy . Resemble herpes gestationis but no veiscles or bullae

Prurigo of pregnancy Papular eruptions of pregnancy Prurigo gestationis and papular dermatitis Prurigo gestationis : small pruritic , rapidly excoriated lesions on the forearms and trunk No vesicles or bullae Onset at 25 to 30 weeks and may persist for 3 months after delivery Recurrence is common Oral antihistamines and topical corticosteriod creams Perinatal outcome : not affected

Herpes gestationis (1)Noninfectious disorderAutoimmue pruritic blistering skin eruption affects multiparous women in late pregnancy and may begin early in pregnancy or within a week or postpartumPemphioid gestationis : immunologically similar to bullous pemphgoid 1/5000 pregnanciesExtremely pruritic widespread eruption with lesions that vary from erythematous and edematous papules to large , tense vesicles and bullae.

Herpes gestationis (2)Topical corticosterioids and oral antihistamines Orally pregnisone 0.5 to 1 mg/kg daily , brings relief and inhibits formation of new lesions The healed sites are not scarred but frequently are hyperpigmentedRefractory cases: immunosuppresives , such as cyclophosphamide , methotrexazte and cyclosporine.Bullous pemphigoid : plasmapheresis and high dose IG therapy

Herpes gestationis (3)

Reports of association with preterm birth , stillbirths and growth restriction

Increased surveillance is recommended

Lesions similar to those of the mother develop in up to 10% of neonates

Preexisting skin disease

Acne: Isotretinoin , etretinate and tretinoin are strictly contradicted in pregnancy – teratogenic Pregnancy : topically applied benzoyl peroxide and clindamycin or erythromycin gel Topical tretinoin is thought to pose no significant teratogenic risk

Preexisting skin disease(2)Psoriasis improves in up to 50% during pregnancy and 20 % worse Localized : Topical corticosteroids calciportriene , antrhalin and tacrolimus Generalized mild disease: UV-B phtotherapy or plus psoralens and oral cyclosporing if unsuccessful Moderate and severe: plus topical or oral corticosteriods Coal tar derviatives as well as oral and systemic immunosupressives ( MTX, cyclosporine , tacrolimus) are avoided

Thank you for your attention