6 skin disorders of pregnancy: A management guide
You can handle most of these dermatoses, but some require referral
IN THIS ARTICLE
FIGURE 5 Pruritic folliculitis of pregnancy
The papules and pustules of PFP are concentrated around hair follicles.
Pathophysiology. Like many other dermatoses of pregnancy, the pathophysiology of PFP is unknown. There is little evidence that the condition is immunologically or hormonally mediated, and there is no evidence of an infectious component.24,28
Differential diagnosis. PFP must be distinguished from infectious folliculitis, acneiform disorders, HIV-associated eosinophilic folliculitis, and a drug reaction.
Diagnosis. The clinical diagnosis is based on presenting symptoms and third-trimester onset. No specific laboratory or histologic analysis can be used to make a definitive diagnosis.
Treatment. As the condition is, by definition, a nonmicrobial folliculitis, the most effective therapy tends to be with a low- or midpotency topical corticosteroid, such as triamcinolone or desonide. A benzoyl peroxide wash can also be effective.
Sequelae. One study reports an increased incidence of low birth weight, but no associated morbidity or mortality has been reported in recent studies.24
- Pemphigoid gestationis is best managed with oral prednisone at doses from 20 to 60 mg per day to control symptoms
- The pruritus associated with pruritic urticarial papules and plaques of pregnancy can be safely and effectively managed with topical corticosteroids and oral antihistamines
- Treat intrahepatic cholestasis of pregnancy with ursodeoxycholic acid, which likely reduces serum bile acids as well as associated fetal morbidity and mortality
