Clinical Review

Skin disease in pregnancy

BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g3489 (Published 03 June 2014) Cite this as: BMJ 2014;348:g3489
  1. Samantha Vaughan Jones, consultant dermatologist1,
  2. Christina Ambros-Rudolph, consultant dermatologist2,
  3. Catherine Nelson-Piercy, professor of obstetric medicine3
  1. 1Department of Dermatology, Ashford and St Peter’s Foundation Trust, Chertsey, Surrey KT16 0PZ, UK
  2. 2Department of Dermatology, Medical University of Graz, Austria
  3. 3Women’s Services, Guy’s and St Thomas’ Foundation Trust, London
  1. Correspondence to: S Vaughan Jones Sam.Vaughan-Jones{at}asph.nhs.uk

Summary points

  • Pregnancy causes changes in the immune system that result in an increase in autoimmune disease and reduction in cell mediated immunity

  • The two commonest skin conditions in pregnancy are atopic eruption of pregnancy and polymorphic eruption of pregnancy

  • Pemphigoid gestationis is a rare autoimmune bullous disease that can cause reduced fetal growth and prematurity

  • Many common skin diseases may flare in pregnancy and treatment may need to be modified for the safety and wellbeing of the mother and fetus

  • Pemphigoid gestationis, pemphigus vulgaris, and systemic lupus erythematosus can all lead to neonatal involvement from passive transfer of maternal antibodies across the placenta

  • Emollients are the mainstay of treatment in reducing pruritus and giving women relief of symptoms

Skin problems are common during pregnancy, but accurate diagnosis can be difficult. Skin changes in pregnancy can be broadly divided into physiological (box 1),1 specific dermatoses of pregnancy, and other common skin diseases in pregnancy.

Box 1 Physiological skin changes in pregnancy

  • Hyperpigmentation—linea nigra, areolae, melasma, naevi, vulvar melanosis

  • Striae distensae—increased in third trimester

  • Pruritus gravidarum—common in the first and second trimester (affects 1 in 5 women)

  • Hair changes—telogen effluvium (post partum)

  • Nail changes—ridging, splitting, distal onycholysis, longitudinal melanonychia

  • Vascular changes—telangectasia, varicosities, pyogenic granulomas, haemangiomas, peripheral oedema

  • Eccrine glands—activity increased (increased sweating)

  • Apocrine glands—activity reduced (reduced sweating and apocrine secretion)

  • Sebaceous glands—activity increased (in third trimester)

  • Immune system—shift from T helper 1 to T helper 2 lymphocyte profile

In our experience of pregnancy skin clinics, approximately 50% of women present with an exacerbation of a common inflammatory skin disease (for example, eczema, psoriasis, acne, rosacea) or a skin infection. Around 30-50% of women present with one of the specific dermatoses of pregnancy (pemphigoid gestationis, polymorphic eruption of pregnancy, or atopic eruption of pregnancy).2 Pregnancy causes specific management issues, and there is often confusion over which treatments can be …

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