SDPA Fall | Live Blog | Dermatoses of Pregnancy
Dr. Joseph English, III MD opened his lecture discussing the physiologic skin changes of pregnancy. Hyperpigmentation is the most common physiologic skin change in pregnancy, affecting up to 90% of women, and is due to increased activity of tyrosine kinase activity.
While eccrine and sebaceous gland activity is increased in pregnancy, apocrine activity is decreased leading to improvement for some patients who suffer from hidradenitis suppurativa. In addition to glandular and pigmentary changes, Dr. English further discussed vascular changes and striae presentations in pregnancy.
The next part of Dr. English’s lecture focused on common and uncommon dermatoses of pregnancy. A common presentation during pregnancy in the first trimester is pruritus gravidarum and while no adverse outcomes have been associated with this condition, increased rates of labor induction and cesarean sections have been observed.
One of the top three causes of premature births include the uncommon (70/10,000 pregnancies), but important presentation, of intrahepatic cholestasis of pregnancy. Patients with this condition typically present with generalized pruritus in the third trimester with or without jaundice (20%). This condition requires intensive fetal monitoring and typically results in induction of labor at 38 weeks of pregnancy.
Did you know that the top 3 cancer presentations in pregnancy and post-partum period are melanoma, breast and cervical cancer? Dr. English urged the provider “not to assume anything” and biopsy any suspicious lesions. For women who are diagnosed with melanoma, they are advised to wait for 2-3years before conceiving again based on the data regarding melanoma recurrence rates. In regards to nevi, Dr. English reports there is no evidence that nevi change in pregnancy. If a patient perceives a change in a nevus in pregnancy and there are features clinically that are concerning, these lesions should be biopsied.
Finally, Dr. English touched on the topic of infections focusing on viruses in the pregnant patient. For patients who are seronegative for varicella, they should receive the vaccine during pregnancy to avoid possible congenital varicella syndrome, infantile varicella or infantile herpes zoster. On the other hand, with herpes zoster in the pregnant patient, there is no influence on the fetus but it is recommended that the neonate avoid contact with the vesicles! Parvovirus B19 was also discussed and if a patient is known to be exposed, and their titers reveal they are not immune, they should be referred to a maternal fetal specialist due to the potential risk of fetal loss, hydrops and fetal anemia.
Lastly, new research reveals that women who are diagnosed with pityriasis rosea in the first 15 weeks of pregnancy have an increased rate of spontaneous abortion and should accordingly be referred to maternal fetal specialists.
Byline: Sarah Patton, PA-C, MSHS
Posted: November 4, 2016