피부과김은형

Predominantly a disease of women in their 1st

pregnancy in the 3rd trimester

Pruritic urticarial papules ; microvesiculation, target like, annular, polycyclic, no bullae

Begin on the abdomen (in the striae in 2/3 of the cases)

Usually sparing the periumbilical area, palms, soles, and face

Recurrence in subsequent pregnancies, with menses or with the use of oral contraceptives; uncommon

10 times more common in women with twins or triplets

Other : primiparous, male fetus, rapid or excessive weight gain

Prognosis unassociated with fetal or maternal morbidity and

mortality

Unknown

Sex hormones Campbell et al; Progesterone has been shown to aggravate the

inflammatory process at the tissue level.

Im et al; increased progesterone receptor immunoreactivity in skin lesions of PUPPP

Damage to connective tissue within the striae distensae rapid abdominal wall distension → damage to connective tissue →

conversion of nonantigenic molecules to antigenic ones →inflammatory process

Fetal cell migration to the maternal skin Nelson et al ; Increased abdominal stretching → increased vascular

permeability → migration of chimeric cells into the maternal skin

Histopathology

Nonspecific perivascular lymphohistiocytic infiltrate with some edema and eosinophils in the dermis

DIF; negative

Treatment

Conservative therapies

Topical emollients and topical corticosteroids

Oral antihistamines

Oral corticosteroids

Prurigo of pregnancy

Pruritic folliculitis of pregnancy

Atopic dermatitis or eczema of pregnancy

Prurigo gestationis

Papular dermatitis of pregnancy

Early onset prurigo of pregnancy

Clinical feautres

intensely pruritic rashes in the 2nd or 3rd trimester

small, mostly excoriated, nonvesicular erythematous papules

grouped over the abdomen and the distal extensor aspects of both upper and lower extremities

propensity to resolve leaving residual PIH

disappearance soon after delivery

Histopathologic examination; nonspecific

DIF; negative

No risk to the fetus or to the mother

Recurrences during subsequent pregnancies; infrequent

Treatment symptomatic

topical steroids

oral antihistamines

systemic steroids

Extremely itchy erythematous follicular papules, pustules localized to the torso

≈ steroid induced acne

Any trimester

(m/c 2nd or 3rd )

May resolve before delivery

No morbidity to the mother or fetus

Biopsy; sterile folliculitis

DIF; negative

Treatment

Topical corticosteroid

Benzoyl peroxide

Emollient

UVB

Eczema of pregnancy

Eczematous lesion typically appear during the 1st and 2nd

trimester

All parts of the body including the face, palms and soles

Eczematous(50%), papular or prurigo-like features (30%)

Etiology: Unknown 20% exacerbation of atopic dermatitis

80% have no past history

Elevated serum IgE in app. 70% of patients

Treatment : topical steroid

Clinical features Markedly pruritic and/or urticarial plaques, papules or

vesicles beginning in the periumbilical region before spreading across the trunk and body, forming bullae

during the 2nd or 3rd trimester sparing of the face, mucous membranes, palms, and

soles

Pathology

subepidermal vesicles, spongiotic epidermis

some perivascular lymphocyte and histiocyte infiltrates with a preponderance of eosinophils

DIF; C3 with or without IgG in a linear band along the BMZ

Immunologic response against class II antigens of paternal haplotype at the placenta, which then cross-reacts with the skin Associations with HLA DR3 (61%-80%), DR4 (52%), or

both (43%-50%) Immunology

HG factor; IgG1 subclass Epitope mapping; common antigenic site within the

noncollagenous domain (NC16A) of the transmembrane180-kD HG Ag (BP Ag 2)

Clinical course Remit before delivery or regresses spontaneously over

weeks or months after delivery Flares At the time of deliveryDuring menstruationOral contraceptives

Occurrences in subsequent pregnanciesearlier more severe clinical pictureprolonged postpartum duration

No maternal risk but an increased risk of Graves’ disease, other

autoimmune diseases

Mild increase in fetal morbidity or mortality small-for-gestational-age infants

- associated with presence of blisters and disease onset in 2nd trimester but not antibody titer or systemic corticosteroid treatment

prematurity

Treatment

Early urticarial lesions

topical corticosteroids in addition to oral antihistamines

First line; (bullae)

systemic corticosteroids (0.5 mg/kg or 30mg/d of prednisolone daily)

Chronic HG

plasmapheresis

박등 (2000); Cyclosporine으로호전을보인임신성포진 1예

IVIG combined with cyclosporine

Refractory cases; adjuvant medications, especially in the postpartum period (methotrexate, azothioprine, gold,pyridoxine, cyclophosphamide)

Alternative ; dapsone, sulfapyridine, pyridoxine, cyclosporine

Classification

a rare form of generalized pustular psoriasis in pregnancy

an entity distinct from psoriasis

Onset; most commonly in the 3rd trimester

Systemic symptoms; malaise, fever, delirium, diarrhea, vomiting, tetany

Usually no personal or family history of psoriasis

Often associated with hypocalcemia or low serum levels of vitamin D

Erythematous patches with grouped pustules at their

margins starting in the intertriginous or flexural areas and

extend centrifugally

Pustular psoriasis occurring during pregnancy tends to worsen as the pregnancy progresses and resolves rapidly at delivery or termination.

Obstetric complications

placental insufficiency; increased risk of stillbirths, fetal abnormalities, neonatal death

fluid and electrolyte imbalance; increased morbidity and mortality

Treatment systemic corticosteroids; usually effective at a relatively low

dose of 15 to 30 mg/day of prednisone

oral cyclosporin (category C)

parenteral calcium with vitamin D

postpartum administration of oral retinoids

Recurrence in successive pregnancies earlier onset and increased morbidity

increase in morbidity with each successive pregnancy

The safety of topical glucocorticoids (C) varies with the strength of the agent and the specific vehicle employed. high potency topical steroids used on large body surface areas

- increased potential for systemic absorption

Not more than 45g/week of potent or 100g /week of weak or moderately potent topical corticosteroid should be applied (without occlusion) if systemic absorption is to be avoided.

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