Pregnancy dermatosis, atopic L30.8

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 09.08.2022

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AEP; Atopic eruption of pregnancy; Atopic pregnancy dermatosis; Early onset Prurigo of pregnancy; Eczema in pregnancy; Papular dermatitis of pregnancy; Pregnancy folliculitis; Pregnancy prurigo; Prurigo gestationis; Pruritic folliculitis of pregnancy

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Besnier 1904

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Second most common dermatosis in pregnancy associated with severe pruritus (about 50% of pruritic dermatoses in pregnancy are due to this diagnosis) in patients with atopic self history or atopic family history.

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50% of all pruritic dermatoses in pregnant women: incidence: 1: 300 to 1: 450

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Exacerbation of the pre-existing atopic eczema in 20% of cases. In all other patients either first manifestation or re-manifestation of a previously existing atopic eczema (e.g. flexural eczema in adolescence).

Exacerbation can be explained by the dominance of a Th2 immunity, which ensures the "survival of the fetal allograft", typical of pregnancy.

The reduced cellular immune response is contrasted by a dominant humoral immune response with increased secretion of Th2 cytokines (IL-4, IL-10) (see also eczema, atopic).

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Frequently (75% of cases) occurring in the 2nd trimester, possibly as early as the 1st trimester.

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Face, neck, décolleté, flexion of the extremities with armpits and groin .

Clinical features
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In the majority of cases (70%) the disease manifests itself for the first time or after years of latency with severe itching. Typically, different stages of eczema can occur: from multiple weeping and scaling papules to multiple, chronically active, flexor-side-emphasized, partly symmetrical, disseminated, dry, possibly scaly, scaly, extensive skin lesions.

In about 30% of the cases, disseminated prurigo-like, itchy papules or nodes on the trunk and extremities are found.

Patients report a very pronounced xerosis cutis.

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IgE increased in 30-70% of cases!

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Non-specific. The eczema patterns can only be evaluated in connection with the clinic.

Direct Immunofluorescence
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Negative (see pemphigoid gestationis).

Differential diagnosis
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Pemphigoid gestationis: vesiculo-bullous HV; onset in 3rd trimester, postpartum; severe pruritus; DIF: linear C3 deposits; histology: subepidermal blister.

Pruritus gravidarum (ICP; see also pregnancy, skin lesions): No primary HV; only scratch excoriations; DIF: nonspecific; laboratory: bile acids elevated.

PUPPP: Papulo-urticarial HV; onset in striae distensae; umbilical region remains exposed; DIF: nonspecific; Laboratory: o.b.; Late onset of HV (3rd trimester or postpartum).

Impetigo herpetiformis: Acute onset with severe impairment of general condition, with marked feeling of illness, fever, chills, possibly diarrhea. Flexural exanthema with bright red, extensive erythema and plaques and pustules. Laboratory: Dysproteinemia; leukocytosis; neutrophilia; iron deficiency with anemia; decreased serum calcium; markedly accelerated ESR; CRP is elevated.

External therapy
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  • Refatting local therapy with urea-containing preparations (unproblematic during pregnancy)
  • First, experiment with bland-free Lotio alba, ethanolic zinc oxide shaking mixture.
  • Cool showers, "cool packs" or moist compresses, e.g. with 0.9% NaCL solution, also have a soothing effect.
  • Polidocanol-containing lotions or creams (e.g. Optiderm®), shaking mixtures or gels provide relief. Especially the gel base has a pleasant, cooling and itch-relieving accompanying effect.
  • Light therapy (UVB) can be helpful in addition.

Internal therapy
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  • For severe and intolerable itching with considerable sleep disturbances glucocorticoids such as prednisone (e.g. Decortin) as short-term therapy (4 weeks). Initial: 0.5-2.0 mg/kg bw/day; continuing: 0.1-0.5 mg/kg bw/day; gradual dose reduction according to clinical findings.
  • The administration of antihistamines during pregnancy is assessed differently in the literature. However, at the most, 1st generation preparations such as clemastine (e.g. Tavegil 2 times/day 1 tbl. p.o. or 2 times/day 1 amp. i.v.); Dimetinden (e.g. Fenistil) or Hydroxyzin (e.g. Atarax 1-3 tbl./day) come into question.

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Good prognosis with rapid response to local therapy. Significant improvement even during pregnancy. Recurrences are frequent in subsequent pregnancies.

No impairment of the fetus known.

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In case of bacterial superinfection, beta-lactam antibiotics and macrolides as well as acyclovir can be used systemically during the entire pregnancy.

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  1. Ambros-Rudolph CM (2006) Dermatoses of pregnancy. J Dtsch Dermatol Ges 4: 748-759
  2. Ambros-Rudolph CM (2010) Specific pregnancy dermatoses. Dermatologist 61: 1014-1020
  3. Roth MM et al (2016) Prurigo, pruritic folliculitis, and atopic eruption of pregnancy: Facts andcontroversies
    .Clin Dermatol 34:392-400.

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Last updated on: 09.08.2022