妊娠期皮膚病

1、Pregnancy dermatoses,2009.08.11,Physiologic skin changes in pregnancyDermatoses exacerbated by pregnancyDermatoses only occurring in pregnancySpecific dermatoses of pregnancy,Physiologic skin changes in pregnancy妊娠期皮

2、膚的生理變化,Hyperpigmentation 色素沉著,Occurs in 90% of pregnant womenIncreased melanocyte-stimulating hormoneAccentuation on areolae, genital skin, and linea albaUsually regresses postpartum,Melasma 黃褐斑,Occurs in 70% of preg

3、nant womenAlso seen with oral contraceptivetherapyCentrofacial, malar, and mandibular patternsExcessive melanin in epidermis or dermal macrophagesWorsens with UVB exposure,Hirsutism 多毛癥,Face, limbs, and backRegresse

4、s within 6 months postpartumSlowed conversion from anagen to telogen hairs,Nail changes 甲改變,Transverse grooving Brittleness Distal onycholysis,Increased eccrine gland activity 內(nèi)分泌腺活性增加,MiliariaDyshidrotic eczemaHyp

5、erhidrosis,Decreased apocrine gland activity大汗腺活動性減少,Hidradenitis suppurativa alleviated,Increased sebaceous gland activity 皮脂腺活動性增加,Exacerbation of acne vulgarisMontgomery’s tubercles enlarge,Striae distensae妊娠紋,Occur

6、 in 90% of pregnant womenPink or purple atrophic longitudinal bandsCaused by increased adrenocortical activityFade postpartum to persistent pale atrophic bands,Vascular changes血管變化,Spider neviPalmar erythemaNonpitti

7、ng facial edemaVenous varicosities: LegsVasomotor instabilityDermographismEdema and hyperemia of gingivae,Dermatoses exacerbated by pregnancy妊娠期加重的皮膚病,Atopic eczema 特應(yīng)性皮炎,May deteriorate or remit during pregnancyli

8、mbs and/or trunk and faceMay present for the first time in pregnancy in predisposed personIrritant hand dermatitis and nipple eczema common postpartumTreatment: topical corticosteroids, emollients, UVB,Psoriasis 銀屑病,M

9、ost 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 preg

10、nancySystemic drugs: retinoids, methotrexate, and hydroxyurea are all contraindicated in pregnancy. Cyclosporine should be used with caution during pregnancy and breast-feeding.,Acne vulgaris尋常痤瘡Urticaria蕁麻疹Lichen pla

11、nus扁平苔蘚,Infections 感染性皮膚病,Viral (herpes simplex, varicella zoster)Bacterial (impetigo, trichomoniasis, leprosy)Fungal (candidal, Pityrosporum folliculitis)AIDS,Lupus erythematosus (LE),Debate continues ：whether lupus

12、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 is seen in babies of mothers w

13、ith 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

14、.Treatment with systemic corticosteroids and antimalarials should not be stopped in pregnancy, to prevent an acute flare.,Systemic sclerosisPolymyositis/DermatomyositisPemphigus,Cutaneous tumors affected by pregnancy,

15、Pyogenic granulomaHemangiomaHemangioendotheliomaGlomus tumorDermatofibromaLeiomyomaKeloidNeurofibromaNeviMelanoma,Dermatoses only occurring in pregnancy僅發(fā)生在妊娠期的皮膚病,Impetigo herpetiformis皰疹樣膿皰病,Reminiscent of pu

16、stular psoriasis, no prior history of psoriasisAssociated with hypoparathyroidism and hypocalcemiaSystemic upset with malaise, fever, delirium, diarrhea, vomiting, and tetany secondary to hypocalcemiaErythematous patc

17、hes with pustular margin in flexural distributionSparing of face, hands, and feetPostinflammatory hyperpigmentation commonHistopathologic features identical to pustular psoriasis with spongiform pustules of Kogoj, lar

18、ge collections of neutrophils within foci of spongiotic epidermisLaboratory findings: Elevated leukocyte count and erythrocyte sedimentation rate, hypocalcemiaTreatment: Prednisolone 30-40 mg dailyPrognosis: Stillbirt

19、h and placental insufficiency still frequently seen even when disease is apparently controlled. Remission postpartum but recurrence in successive pregnancies occurs frequently.,Intrahepatic cholestasis of pregnancy妊娠期肝臟

20、內(nèi)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 deficiency

21、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 cana

22、liculi, staining of parenchyma with bile pigments and minimal inflammation. These changes are reversible postpartum.Pathophysiology: Associated with HLA subtype B8 and BW16 and positive family history in up to 50% of ca

23、ses. Physiologic concentrations of estrogens thought to interfere with hepatic bile acid secretionAbnormal serum liver function tests (LFTs) and elevated serum bile acids confirm the diagnosis Treatment: Antipruritic e

24、mollients, Ion-exchange resins , UVB, evening primrose oil.Prognosis: Increased rate of fetal distress, stillbirth, and preterm delivery.,Specific dermatoses of pregnancy妊娠特異性皮膚病,Pruritic urticarial papules and plaques

25、 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

26、Onset with pruritus within striae on abdomen; periumbilical sparing may occurClinically characterized by various lesions including erythematous plaques, papules, vesicles, purpura, and erythema multiforme–like lesions

27、Subsequent spread to breasts, upper thighs, and arms, sparing faceSerologic and immunofluorescence tests negativeSubtype described in which IgM deposition seen either on direct or indirect immunofluorescence Histopath

28、ologic 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

29、wall distension caused by pregnancy,Prurigo 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 d

30、escribed as papular dermatitis of pregnancyPruritic papules on extensor aspects of limbs and on abdomenNormal maternal and fetal prognosisHistopathologic features: Chronic inflammatory cell infiltrate in upper dermis

31、with occasional epidermal featuresPathophysiology: Unknown, although thought to be a result of physiologic pruritus in women with an atopic backgroundTreatment: Moderately potent topical corticosteroids, antihistamines

32、Prognosis: No adverse effects to mother or infant; resolution postpartum,Herpes gestationis 妊娠皰疹,Autoimmune bullous disorder, closely related to bullous pemphigoid (BP)Rare with incidence of approximately 1 in 60,000O

33、nset usually in second 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

34、 PG has a subsequent unaffected pregnancy)Pruritic erythematous plaques, which become annular or polycyclic, developing into vesicles or bullaePeriumbilical involvement in 87% of casesTransplacental transfer of antibo

35、dies can result in neonatal involvementAssociated with low birth weight and premature birth caused by placental insufficiencyHistopathologic features: Similar to PEP in early phases; subepidermal separation with basal

36、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 immunofl

37、uorescence 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 found in se

38、rum of patients with PGTreatment: Mild cases will respond to potent topical steroids; most cases require systemic corticosteroids with gradual dose reduction as disease remits; postpartum flare often occurs; oral contra

39、ceptive therapy also leads to disease flare; Goserelin (LHRH analogue)(chemical oophorectomy) used in severe cases in postpartum phase,,Pruritic folliculitis of pregnancy妊娠瘙癢性毛囊炎,Pruritic erythematous follicular papules

40、 and urticarial lesions on limbs and abdomen in most casesOnset in second and third trimester with resolution within 2 to 3 weeks postpartumHistopathologic features: Acute folliculitis with mixed inflammatory cells, up