HistoryThis section has been translated automatically.
DefinitionThis section has been translated automatically.
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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Occurrence/EpidemiologyThis section has been translated automatically.
50% of all pruritic dermatoses in pregnant women: incidence: 1: 300 to 1: 450
EtiopathogenesisThis 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).
ManifestationThis section has been translated automatically.
Frequently (75% of cases) occurring in the 2nd trimester, possibly as early as the 1st trimester.
LocalizationThis section has been translated automatically.
Face, neck, décolleté, flexion of the extremities with armpits and groin .
Clinical featuresThis 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.
LaboratoryThis section has been translated automatically.
IgE increased in 30-70% of cases!
HistologyThis section has been translated automatically.
Direct ImmunofluorescenceThis section has been translated automatically.
Differential diagnosisThis section has been translated automatically.
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 therapyThis 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 therapyThis 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/forecastThis 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.
LiteratureThis section has been translated automatically.
- Ambros-Rudolph CM (2006) Dermatoses of pregnancy. J Dtsch Dermatol Ges 4: 748-759
- Ambros-Rudolph CM (2010) Specific pregnancy dermatoses. Dermatologist 61: 1014-1020
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;
Outgoing links (17)Aciclovir; Antihistamines, systemic; Atopic dermatitis (overview); Clemastine; Dimetinden; Hydroxycin; Impetigo herpetiformis; Macrolides; Pemphigoid gestationis; Phototherapy; ... Show all
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