Pregnancy dermatosis, atopic L30.8

Author: Prof. Dr. med. Peter Altmeyer

All authors of this article

Last updated on: 29.10.2020

Dieser Artikel auf Deutsch

Synonym(s)

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

History
This section has been translated automatically.

Besnier 1904

Definition
This section has been translated automatically.

Most frequent dermatosis in pregnancy accompanied by severe pruritus (about 50% of the itching dermatoses in pregnancy are due to this diagnosis) in patients with atopic self- or family anamnesis.

Occurrence/Epidemiology
This section has been translated automatically.

50% of all itching dermatoses in pregnant women

Etiopathogenesis
This section has been translated automatically.

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).

Manifestation
This section has been translated automatically.

Frequently (75% of cases) occurring in the 2nd trimenon.

Localization
This section has been translated automatically.

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

Clinical features
This section has been translated automatically.

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.

Laboratory
This section has been translated automatically.

IgE increased in 30-70% of cases!

Histology
This section has been translated automatically.

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

Direct Immunofluorescence
This section has been translated automatically.

Negative (see pemphigoid gestationis).

Differential diagnosis
This section has been translated automatically.

Pemphigoid gestationis: vesiculo-bullous HV; onset in the 3rd trimenon, postpartum; severe itching; DIF: linear C3 deposits; histology: subepidermal oedema bladder.

Pruritus gravidarum (ICP; see also pregnancy, skin changes): no primary HV; only scratch excoriations; DIF: unspecific; Labbor: increased bile acids.

PUPPP: Papulo-urticular HV; Start in striae distensae; Umbilical region remains free; DIF: unspecific; Laboratory: o.b.; Later start of HV (3rd trimester or postpartum)

Impetigo herpetiformis: Acute onset with severe impairment of the general condition, with a pronounced feeling of illness, fever, chills, possibly diarrhoea. Bending exanthema with highly red, extensive erythema and plaques and pustules. Laboratory: dysproteinemia; leucocytosis; neutrophilia; iron deficiency with anemia; decreased serum calcium; significantly accelerated SPA; CRP is elevated.

External therapy
This section has been translated automatically.

  • 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
This section has been translated automatically.

  • 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.

Progression/forecast
This section has been translated automatically.

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.

Note(s)
This section has been translated automatically.

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

Literature
This section has been translated automatically.

  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.

Incoming links (1)

Pregnancy prurigo;

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

Authors

Last updated on: 29.10.2020