妊娠期皮肤病

妊娠期皮肤病PhysiologicskinchangesinpregnancyDermatosesexacerbatedbypregnancyDermatosesonlyoccurringinpregnancySpecificdermatosesofpregnancyPhysiologicskinchangesinpregnancy

妊娠期皮肤的生理变化

Hyperpigmentation色素沉着

Occursin90%ofpregnantwomenIncreasedmelanocyte-stimulatinghormoneAccentuationonareolae,genitalskin,andlineaalbaUsuallyregressespostpartumMelasma黄褐斑Occursin70%ofpregnantwomenAlsoseenwithoralcontraceptivetherapyCentrofacial,malar,andmandibularpatternsExcessivemelanininepidermisordermalmacrophagesWorsenswithUVBexposureHirsutism多毛症Face,limbs,andbackRegresseswithin6monthspostpartumSlowedconversionfromanagentotelogenhairsNailchanges甲改变

TransversegroovingBrittlenessDistalonycholysisIncreasedeccrineglandactivity

内分泌腺活性增加MiliariaDyshidroticeczemaHyperhidrosisDecreasedapocrineglandactivity

大汗腺活动性减少

HidradenitissuppurativaalleviatedIncreasedsebaceousglandactivity皮脂腺活动性增加

ExacerbationofacnevulgarisMontgomery’stuberclesenlargeStriaedistensae妊娠纹Occurin90%ofpregnantwomenPinkorpurpleatrophiclongitudinalbandsCausedbyincreasedadrenocorticalactivityFadepostpartumtopersistentpaleatrophicbandsVascularchanges血管变化SpiderneviPalmarerythemaNonpittingfacialedemaVenousvaricosities:LegsVasomotorinstabilityDermographismEdemaandhyperemiaofgingivaeDermatosesexacerbatedbypregnancy

妊娠期加重的皮肤病

Atopiceczema特应性皮炎Maydeteriorateorremitduringpregnancylimbsand/ortrunkandfaceMaypresentforthefirsttimeinpregnancyinpredisposedpersonIrritanthanddermatitisandnippleeczemacommonpostpartumTreatment:topicalcorticosteroids,emollients,UVBPsoriasis银屑病Mostcommontype:chronicplaquepsoriasisDifferentialdiagnosisofpustularvariantfromimpetigoherpetiformismaybedifficultTopicaltreatment:Dithranol,calcipotriol,tar,andcorticosteroidsareallsafeinpregnancySystemicdrugs:retinoids,methotrexate,andhydroxyureaareallcontraindicatedinpregnancy.Cyclosporineshouldbeusedwithcautionduringpregnancyandbreast-feeding.Acnevulgaris寻常痤疮

Urticaria荨麻疹

Lichenplanus扁平苔藓

Infections感染性皮肤病Viral(herpessimplex,varicellazoster)Bacterial(impetigo,trichomoniasis,leprosy)Fungal(candidal,Pityrosporumfolliculitis)AIDSLupuserythematosus(LE)Debatecontinues：whetherlupusflaresaremorecommoninpregnancy.Cutaneousflaresarethemostcommon,followedbyarthritis.Painfulvasculiticlesionsontheperipheriesarethemostcommonskinlesions.NeonatalLEisseeninbabiesofmotherswithcirculatinganti-Ro(SSA)antibodiesandcanleadtocongenitalheartblock.Theantiphospholipidsyndromepresentswiththrombosis,recurrentmiscarriage,livedoreticularis,migraine,stroke,and/orthrombocytopenia.Treatmentwithsystemiccorticosteroidsandantimalarialsshouldnotbestoppedinpregnancy,topreventanacuteflare.Systemicsclerosis

Polymyositis/Dermatomyositis

Pemphigus

Cutaneoustumorsaffectedbypregnancy

PyogenicgranulomaHemangiomaHemangioendotheliomaGlomustumorDermatofibromaLeiomyomaKeloidNeurofibromaNeviMelanomaDermatosesonlyoccurringinpregnancy

仅发生在妊娠期的皮肤病Impetigoherpetiformis疱疹样脓疱病

Reminiscentofpustularpsoriasis,nopriorhistoryofpsoriasisAssociatedwithhypoparathyroidismandhypocalcemiaSystemicupsetwithmalaise,fever,delirium,diarrhea,vomiting,andtetanysecondarytohypocalcemiaErythematouspatcheswithpustularmargininflexuraldistributionSparingofface,hands,andfeetPostinflammatoryhyperpigmentationcommonHistopathologicfeaturesidenticaltopustularpsoriasiswithspongiformpustulesofKogoj,largecollectionsofneutrophilswithinfociofspongioticepidermisLaboratoryfindings:Elevatedleukocytecountanderythrocytesedimentationrate,hypocalcemiaTreatment:Prednisolone30-40mgdailyPrognosis:Stillbirthandplacentalinsufficiencystillfrequentlyseenevenwhendiseaseisapparentlycontrolled.Remissionpostpartumbutrecurrenceinsuccessivepregnanciesoccursfrequently.Intrahepaticcholestasisofpregnancy

妊娠期肝脏内胆汁郁积IncreasedincidencePresentsinthirdtrimesterwithsevereintractablepruritusClinical:Oftenonlyexcoriations;clinicaljaundicerare;mal-absorptionoffatcanleadtoweightlossandvitaminKdeficiencyinseverecasesUsuallynonresponsivetoantihistaminesandtopicalemollientsHistopathologicfindings:Skinfindingsnonspecific;liverbiopsyspecimenwillrevealtypicalchangesinseverecaseswithdilatedbilecanaliculi,stainingofparenchymawithbilepigmentsandminimalinflammation.Thesechangesarereversiblepostpartum.Pathophysiology:AssociatedwithHLAsubtypeB8andBW16andpositivefamilyhistoryinupto50%ofcases.PhysiologicconcentrationsofestrogensthoughttointerferewithhepaticbileacidsecretionAbnormalserumliverfunctiontests(LFTs)andelevatedserumbileacidsconfirmthediagnosisTreatment:Antipruriticemollients,Ion-exchangeresins,UVB,eveningprimroseoil.Prognosis:Increasedrateoffetaldistress,stillbirth,andpretermdelivery.Specificdermatosesofpregnancy

妊娠特异性皮肤病

Pruriticurticarialpapulesandplaquesofpregnancy(PUPPP)妊娠多形疹Incidencebetween1in160womenand1in300PresentsinprimiparouswomeninthirdtrimesterorpostpartumIncreasedincidenceinmultiplepregnancyRarerecurrenceinsubsequentpregnanciesOnsetwithprurituswithinstriaeonabdomen;periumbilicalsparingmayoccurClinicallycharacterizedbyvariouslesionsincludingerythematousplaques,papules,vesicles,purpura,anderythemamultiforme–likelesionsSubsequentspreadtobreasts,upperthighs,andarms,sparingfaceSerologicandimmunofluorescencetestsnegativeSubtypedescribedinwhichIgMdepositionseeneitherondirectorindirectimmunofluorescenceHistopathologiccharacteristics:SpongiosisinepidermiswithperivascularorupperdermalchronicinflammatorycellinfiltratePathophysiology:Unknown,althoughseveraltheoriesincludingtheroleofsexhormonesandabdominalwalldistensioncausedbypregnancyPrurigoofpregnancy妊娠痒疹

DescribedbyBesnierin1904Incidenceapproximately1in300SimilartonodularprurigoseeninnonpregnantpersonsLikelytobesameeruptionthatSpanglerdescribedaspapulardermatitisofpregnancyPruriticpapulesonextensoraspectsoflimbsandonabdomenNormalmaternalandfetalprognosisHistopathologicfeatures:ChronicinflammatorycellinfiltrateinupperdermiswithoccasionalepidermalfeaturesPathophysiology:Unknown,althoughthoughttobearesultofphysiologicpruritusinwomenwithanatopicbackgroundTreatment:Moderatelypotenttopicalcorticosteroids,antihistaminesPrognosis:Noadverseeffectstomotherorinfant;resolutionpostpartumHerpesgestationis妊娠疱疹

Autoimmunebullousdisorder,closelyrelatedtobullouspemphigoid(BP)Rarewithincidenceofapproximately1in60,000OnsetusuallyinsecondandthirdtrimesterorpostpartumperiodRecurrencecommoninsubsequentpregnancyatearliergestationandwithincreasedseverity(apartfromskippregnancies,whichoccurwhenawomanwithknownPGhasasubsequentunaffectedpregnancy)Pruriticerythematousplaques,whichbecomeannularorpolycyclic,developingintovesiclesorbullaePeriumbilicalinvolvementin87%ofcasesTransplacentaltransferofantibodiescanresultinneonatalinvolvementAssociatedwithlowbirthweightandprematurebirthcausedbyplacentalinsufficiencyHistopathologicfeatures:SimilartoPEPinearlyphases;subepidermalseparationwithbasalcellnecrosis;eosinophilicspongiosisImmunofluorescencediagnostictest:PositivedirectimmunofluorescencewithIgGandcomplement3stainingatthebasementmembranezoneandstainingtotheroofonindirectimmunofluorescenceusingsalt-splitskinPathophysiology:HLA-DR3,DR4subtypesassociated;closerelationshiptoBP,sharingsametargetantigenBP-180kd(BP-AG2),acomponentofhemi