During pregnancy, there are marked changes in sex hormones, the immune system, and the cardiovascular system, and this can lead to changes in the skin......

1. Skin Changes and Diseases
in Pregnancy
Dr. Syeda Ishrat Jahan
Consultant Dermatologist
Square Hospitals Limited

2. SKIN CHANGES IN PREGNANCY
Definition:
Pregnancy is a physiological condition
characterized by endocrine, metabolic and
immunologic changes.
There are physiological, pathological
changes and aggravation of pre-existing
diseases during pregnancy.

3. Physiological changes during pregnancy can be
described as follows:
Pigmentary changes
There is diffuse hyperpigmentation including
specific increased pigmentation of genitalia,
areolae and axillae, darkening of the existing
freckles and melanocytic naevi and linea nigra.
Melasma is a specific facial hyperpigmentation
seen in some pregnant women.

7. Trichological changes
Trichological changes are hirsutism and
hypertrichosis with increased pigmentation of
hair; scalp hairs are increased in number due to
hormonal influence.

8. Onychological changes
There are a lot of nail changes of pregnancy
including onychorexis, distal onycholysis,
subungual hyperkeratosis, increased prominent
transverse groove, and growth is accelerated.

9. Mechanical changes in structure
There are prominent striae of the abdomen and
also minimum striae on other parts of the body
which are called striae gravidarum.

10. Vascular changes
Whole skin surface of the body looks hyperemic
with palmar erythema, spider angioma, purpura
and telangiectasia which are common vascular
changes of skin in pregnancy.

11. Mucosal changes
Mild gingivitis, bluish discolouration of vagina
and cervix are the commonest mucosal changes
in pregnancy.

12. SKIN DISEASES IN PREGNANCY
Classification of dermatoses of pregnancy,
as proposed by Holmes and Black.

13. 1. Pemphigoid gestationis
or herpes gestationis
Pemphigoid gestationis is an intensely pruritic,
urticarial and vesiculobullous, rare autoimmune
disorder which occurs in pregnancy. It begins in
the second or third trimester.

14. 2. Polymorphic eruption of pregnancy (PEP) or
pruritic urticarial papules and plaques of
pregnancy [PUPPP]
PEP or PUPPP is the second most common
dermatosis of pregnancy. It is a benign dermatosis
that usually arises late in the third trimester of a
first pregnancy.

15. PUPPP is manifested with intensely pruritic
papules arising within striae distension late in the
third trimester of a first pregnancy.
Erythematous urticarial papules and plaques of
the trunk and extremities are also observed,
although the periumbilical area is spared

16. 3. Atopic Eruption of Pregnancy (AEP) or
Early-onset prurigo of pregnancy (EPP)
It is considered that early-onset prurigo of
pregnancy, a relatively common pruritic
dermatosis, is defined as part of a disease
complex with atopic eruption in pregnancy.

17. This type of eruption in pregnancy is manifested
with discrete, pruritic, excoriated papules with
typical onset during the second trimester of
pregnancy
It is more common in women with an atopic
background. Simple prurigo of pregnancy has a
predilection for extensor surfaces, although atopic
eruption of pregnancy has a predilection for
flexural skin.

18. 4. Pruritic folliculitis of pregnancy (PF)
It is a rare dermatosis of pregnancy which occurs
in the second and third trimester of pregnancy. It is
characterized by an acneiform eruption consisting
of multiple, pruritic, monomorphous, follicular
papules or pustules which are usually seen on the
shoulders, upper back, arms, chest, and abdomen.

19. 5. Intrahepatic cholestasis with dermatoses of
pregnancy (ICP)
Intrahepatic cholestasis of pregnancy is defined as
pruritus with onset in pregnancy, which is
associated with abnormal liver function in the
absence of other liver disease, and which resolves
typically in the immediate postpartum period.

20. 6. Pustular psoriasis of pregnancy (PPP) or
Impetigo Herpetiformis
Pustular psoriasis of pregnancy is a form of
psoriasis that occurs during the third trimester of
pregnancy and is manifested by pustules rather
than typical skin lesions.

21. Thank You.