MEDLINE Abstracts: Dermatoses During Pregnancy

April 24, 2002

MEDLINE Abstracts: Dermatoses During Pregnancy

Fuhrman L
J Perinat Neonatal Nurs. 2000;14:1-16

Awareness of pregnancy-related skin changes can facilitate improved care of women during pregnancy by identifying those skin changes that require further evaluation. Women experience significant endocrine and metabolic changes during pregnancy that can cause both physiologic and pathologic alterations in the skin, nails, and hair. This review discusses the physiologic changes and pruritic dermatoses that are specifically associated with pregnancy. The effect of pregnancy on preexisting skin diseases and safe treatment options for usage during pregnancy will be provided.

Erbagci Z, Erkilic S
Int J Clin Pract. 2000; 54:619-620

Impetigo herpetiformis is a rare non-infectious pustular dermatosis of pregnancy. A few non-gestational cases due to oral contraceptive use have also been reported. Although the disorder is not thought to have a genetic background, there are some familial case reports in the literature. We describe a case of recurrent impetigo herpetiformis in an 18-year-old pregnant woman who had normal serum calcium levels and responded well to prednisolone therapy. Interestingly, the patient's mother had also experienced a generalised pustular dermatosis associated with hypocalcaemia during oral contraceptive use, which was diagnosed clinically and histologically as impetigo herpetiformis.

Engineer L, Bhol K, Ahmed AR
Am J Obstet Gynecol. 2000;183:48

Pemphigoid gestationis is a rare autoimmune vesiculobullous skin disease closely related to the pemphigoid group of blistering disorders. It is unique in that it is most frequently associated with pregnancy. Diagnosis is made on the basis of the presence of a subepidermal vesicle on routine histologic examination and of linear deposition of the third component of complement along the basement membrane zone of perilesional skin. Abnormal expression of major histocompatibility complex class II molecules in the placenta may trigger the initiating immunologic event in this organ, which is followed by cross-reactivity with an antigen present in the skin and the characteristic cutaneous signs of the disease. The immunogenetics of this disorder are interesting. A role for the involvement of major histocompatibility complex class II antigens seems likely because of the association with human leukocyte antigens DR3 and DR4. Major histocompatibility complex class III associations have also been observed, as has a high frequency of anti-human leukocyte antigen antibodies. We review the current understanding of the molecular biologic and immunogenetic properties of this disease and discuss treatment and potential impact on the fetus.

Kroumpouzos G, Cohen LM
J Am Acad Dermatol. 2000;43:132-134

Pruritic folliculitis of pregnancy is a rare pregnancy dermatosis that clears spontaneously in the postpartum period. We describe a patient with characteristic clinical and histopathologic features of this dermatosis.

Harris MN, Desai R, Chuang TY, Hood AF, Mirowski GW
J Am Acad Dermatol. 2000;42:1012-1016

Background: Lobular capillary hemangiomas (pyogenic granulomas) occur on both mucosal and cutaneous surfaces. There are conflicting data regarding the increased prevalence of lobular capillary hemangiomas in female versus male subjects. Some studies have noted a female predominance of lobular capillary hemangiomas, but other studies do not reveal such a disparity. Because of an increased prevalence during pregnancy, oral tumors are also known as "granuloma gravidarum" or "pregnancy tumors." A hormonal influence for these mucosal lesions has been postulated. There are, however, no studies that address a possible relationship between hormones and cutaneous lesions.
Objective: This study presents the epidemiology of lobular capillary hemangiomas, with an emphasis on cutaneous lesions.
Methods: We reviewed 63,759 dermatopathology reports from a regional, private dermatopathology laboratory and found 325 cases of lobular capillary hemangiomas over a 1-year period.
Results: In our study of lobular capillary hemangiomas, cutaneous lesions accounted for 86%, with mucosal lesions representing only 12% of cases. Seven cases were excluded (one was intravascular, two were subcutaneous, and in 4 the location was not specified). Overall, male patients outnumbered female patients. The peak incidence for cutaneous lobular capillary hemangiomas was found in the second decade of life. The most common cutaneous sites were the trunk, upper extremities, and head. Mucosal lesions were primarily seen on the lips, gingiva, and tongue, and these affected females more than males by a ratio of 2:1, most commonly in the fourth decade of life.
Conclusion: Cutaneous lobular capillary hemangiomas were equally prevalent in male and female patients. This would refute a female hormonal influence in the induction of cutaneous lobular capillary hemangiomas. Our data may suggest a hormonal influence on mucosal lesions because mucosal lobular capillary hemangiomas were twice as common in female patients. However, the small number of lesions in our study precludes us from making such a conclusion.

Saenz-Badillos J, Brady MS
J Surg Oncol. 2000;73:231-233

We report of a case of malignant melanoma occurring during pregnancy in a woman whose mother had a melanoma excised during pregnancy. There was no other family history of melanoma. To our knowledge, this has not been previously reported. A review of the recent literature suggests that pregnant women with melanoma do not have a worse prognosis when compared to matched controls, but may present with worse prognostic features.

Young GL, Jewell D
Cochrane Database Syst Rev. 2000;(2):CD000027

Background: While not common, itching in pregnancy (not due to liver disease) can be distressing.
Objectives: The objective of this review was to assess the effects of treatment for itching in late pregnancy.
Search Strategy: We searched the Cochrane Pregnancy and Childbirth Group trials register. In addition, the Cochrane Controlled Trials Register (CENTRAL/CCTR) wa searched. Date of last search: April 1999.
Selection Criteria: Randomised trials of treatments for itching in women in late pregnancy with normal liver function.
Data Collection And Analysis: Trial quality was assessed and data were extracted independently by two reviewers.
Main Results: One study of 38 women was included. This was a small crossover trial, using alternate allocation. The trial compared a histamine, chlorpheniramine, with aspirin. Aspirin was more effective than chlorpheniramine in relieving itching (odds ratio 2. 39, 95% confidence interval 1.25 to 4.57). However chlorpheniramine was more effective than aspirin when a rash was present.
Reviewer's Conclusions: Aspirin appears to be more effective than chlorpheniramine for relief of itching in pregnancy when no rash is present. If there is a rash, chlorpheniramine may be more effective.

Lee HJ, Ha SJ, Lee SJ, Kim JW.
J Am Acad Dermatol. 2000; 42:936-938

Melanocytic nevi are commonly believed to undergo changes during pregnancy. This is probably related to hormonal influences; however, few studies have been able to prove it. We observed a case of a benign melanocytic nevus, which showed significant enlargement during pregnancy and immediate postpartum regression associated with increased apoptosis of nevus cells. Estrogen and progesterone receptors were not found in our case, although the clinical course still suggested a close association with hormonal influences.

Chen FC, von Dehn D, Buscher U, Dudenhausen JW, Niggemann B.
Am J Obstet Gynecol. 1999;181:1461-1464

Objective: Our purpose was to assess the prevalence of latex sensitization among women admitted for delivery and the relevant risk factors.
Study Design: In a prospective study 333 consecutive patients admitted for delivery were screened for specific immunoglobulin E antibodies to latex and for atopic status. A questionnaire was filled in and included questions about the obstetric and surgical history, known contact with latex, and previous use of condoms.
Results: Nine of 333 (2.7%) women showed latex-specific immunoglobulin E. All 9 women had atopy (100% vs 26. 2% in the latex-negative group; P É.00001). Of 8 patients with specific immunoglobulin E who gave details about the use of condoms, 6 had had frequent contact with latex condoms (75% vs 51%) Previous cesarean delivery was more frequent in latex-sensitized patients (33% vs 8.4%; P <.05), whereas previous pregnancies, previous deliveries, and total number of operations had no influence.
Conclusion: Given a prevalence of 2.7% of latex sensitization, all obstetric patients should be questioned about known immediate allergic reaction to latex, a predisposition to atopy, previous intra-abdominal operations, and the regular use of condoms in the past. Patients with atopy and additive risk factors should be treated in a latex-free environment.

Wrone DA, Duncan LM, Sober AJ
J Gend Specif Med.1999;2:52-54

In a question-and-discussion format, the authors summarize the major studies on melanoma and pregnancy. The laboratory studies reviewed give conflicting results; however, excellent epidemiologic studies suggest that pregnancy and melanoma are not closely linked. Specifically, the prognosis of pregnant women with melanoma is similar to the prognosis of nonpregnant women with melanoma of equal tumor thickness, and melanoma is neither more nor less likely to occur in previously pregnant women. Some studies have shown that pregnant women have melanomas that are thicker than nonpregnant women's melanomas. The reason is unclear, but it may be because malignant changes in pigmented lesions during pregnancy have been ignored. Treatment options for pregnant women with melanoma are limited, but early detection and surgical excision of thin melanomas is the goal. Changes in mole size or color during pregnancy can be normal, but all changing moles warrant careful examination, and irregular or asymmetric change is suspicious for melanoma.