妊娠期皮膚病PhysiologicskinchangesinpregnancyDermatosesexacerbatedbypregnancyDermatosesonlyoccurringinpregnancySpecificdermatosesofpregnancy2021/4/272Physiologicskinchangesinpregnancy

妊娠期皮膚的生理變化

2021/4/2732021/4/274Hyperpigmentation色素沉著

Occursin90%ofpregnantwomenIncreasedmelanocyte-stimulatinghormoneAccentuationonareolae,genitalskin,andlineaalbaUsuallyregressespostpartum2021/4/275Melasma黃褐斑Occursin70%ofpregnantwomenAlsoseenwithoralcontraceptivetherapyCentrofacial,malar,andmandibularpatternsExcessivemelanininepidermisordermalmacrophagesWorsenswithUVBexposure2021/4/276Hirsutism多毛癥Face,limbs,andbackRegresseswithin6monthspostpartumSlowedconversionfromanagentotelogenhairs2021/4/277Nailchanges甲改變

TransversegroovingBrittlenessDistalonycholysis2021/4/278Increasedeccrineglandactivity

內(nèi)分泌腺活性增加MiliariaDyshidroticeczemaHyperhidrosis2021/4/279Decreasedapocrineglandactivity

大汗腺活動性減少

Hidradenitissuppurativaalleviated2021/4/2710Increasedsebaceousglandactivity皮脂腺活動性增加

ExacerbationofacnevulgarisMontgomery’stuberclesenlarge2021/4/2711Striaedistensae妊娠紋Occurin90%ofpregnantwomenPinkorpurpleatrophiclongitudinalbandsCausedbyincreasedadrenocorticalactivityFadepostpartumtopersistentpaleatrophicbands2021/4/2712Vascularchanges血管變化SpiderneviPalmarerythemaNonpittingfacialedemaVenousvaricosities:LegsVasomotorinstabilityDermographismEdemaandhyperemiaofgingivae2021/4/2713Dermatosesexacerbatedbypregnancy

妊娠期加重的皮膚病

2021/4/27142021/4/2715Atopiceczema特應(yīng)性皮炎Maydeteriorateorremitduringpregnancylimbsand/ortrunkandfaceMaypresentforthefirsttimeinpregnancyinpredisposedpersonIrritanthanddermatitisandnippleeczemacommonpostpartumTreatment:topicalcorticosteroids,emollients,UVB2021/4/2716Psoriasis銀屑病Mostcommontype:chronicplaquepsoriasisDifferentialdiagnosisofpustularvariantfromimpetigoherpetiformismaybedifficultTopicaltreatment:Dithranol,calcipotriol,tar,andcorticosteroidsareallsafeinpregnancySystemicdrugs:retinoids,methotrexate,andhydroxyureaareallcontraindicatedinpregnancy.Cyclosporineshouldbeusedwithcautionduringpregnancyandbreast-feeding.2021/4/2717Acnevulgaris尋常痤瘡

Urticaria蕁麻疹

Lichenplanus扁平苔蘚

2021/4/2718Infections感染性皮膚病Viral(herpessimplex,varicellazoster)Bacterial(impetigo,trichomoniasis,leprosy)Fungal(candidal,Pityrosporumfolliculitis)AIDS2021/4/2719Lupuserythematosus(LE)Debatecontinues：whetherlupusflaresaremorecommoninpregnancy.Cutaneousflaresarethemostcommon,followedbyarthritis.Painfulvasculiticlesionsontheperipheriesarethemostcommonskinlesions.NeonatalLEisseeninbabiesofmotherswithcirculatinganti-Ro(SSA)antibodiesandcanleadtocongenitalheartblock.Theantiphospholipidsyndromepresentswiththrombosis,recurrentmiscarriage,livedoreticularis,migraine,stroke,and/orthrombocytopenia.Treatmentwithsystemiccorticosteroidsandantimalarialsshouldnotbestoppedinpregnancy,topreventanacuteflare.2021/4/2720Systemicsclerosis

Polymyositis/Dermatomyositis

Pemphigus

2021/4/2721Cutaneoustumorsaffectedbypregnancy

PyogenicgranulomaHemangiomaHemangioendotheliomaGlomustumorDermatofibromaLeiomyomaKeloidNeurofibromaNeviMelanoma2021/4/2722Dermatosesonlyoccurringinpregnancy

僅發(fā)生在妊娠期的皮膚病2021/4/2723Impetigoherpetiformis皰疹樣膿皰病

Reminiscentofpustularpsoriasis,nopriorhistoryofpsoriasisAssociatedwithhypoparathyroidismandhypocalcemiaSystemicupsetwithmalaise,fever,delirium,diarrhea,vomiting,andtetanysecondarytohypocalcemiaErythematouspatcheswithpustularmargininflexuraldistributionSparingofface,hands,andfeetPostinflammatoryhyperpigmentationcommonHistopathologicfeaturesidenticaltopustularpsoriasiswithspongiformpustulesofKogoj,largecollectionsofneutrophilswithinfociofspongioticepidermisLaboratoryfindings:Elevatedleukocytecountanderythrocytesedimentationrate,hypocalcemiaTreatment:Prednisolone30-40mgdailyPrognosis:Stillbirthandplacentalinsufficiencystillfrequentlyseenevenwhendiseaseisapparentlycontrolled.Remissionpostpartumbutrecurrenceinsuccessivepregnanciesoccursfrequently.2021/4/2724Intrahepaticcholestasisofpregnancy

妊娠期肝臟內(nèi)膽汁郁積IncreasedincidencePresentsinthirdtrimesterwithsevereintractablepruritusClinical:Oftenonlyexcoriations;clinicaljaundicerare;mal-absorptionoffatcanleadtoweightlossandvitaminKdeficiencyinseverecasesUsuallynonresponsivetoantihistaminesandtopicalemollientsHistopathologicfindings:Skinfindingsnonspecific;liverbiopsyspecimenwillrevealtypicalchangesinseverecaseswithdilatedbilecanaliculi,stainingofparenchymawithbilepigmentsandminimalinflammation.Thesechangesarereversiblepostpartum.Pathophysiology:AssociatedwithHLAsubtypeB8andBW16andpositivefamilyhistoryinupto50%ofcases.PhysiologicconcentrationsofestrogensthoughttointerferewithhepaticbileacidsecretionAbnormalserumliverfunctiontests(LFTs)andelevatedserumbileacidsconfirmthediagnosisTreatment:Antipruriticemollients,Ion-exchangeresins,UVB,eveningprimroseoil.Prognosis:Increasedrateoffetaldistress,stillbirth,andpretermdelivery.2021/4/2725Specificdermatosesofpregnancy

妊娠特異性皮膚病

2021/4/2726Pruriticurticarialpapulesandplaquesofpregnancy(PUPPP)妊娠多形疹I(lǐng)ncidencebetween1in160womenand1in300PresentsinprimiparouswomeninthirdtrimesterorpostpartumIncreasedincidenceinmultiplepregnancyRarerecurrenceinsubsequentpregnanciesOnsetwithprurituswithinstriaeonabdomen;periumbilicalsparingmayoccurClinicallycharacterizedbyvariouslesionsincludingerythematousplaques,papules,vesicles,purpura,anderythemamultiforme–likelesionsSubsequentspreadtobreasts,upperthighs,andarms,sparingfaceSerologicandimmunofluorescencetestsnegativeSubtypedescribedinwhichIgMdepositionseeneitherondirectorindirectimmunofluorescenceHistopathologiccharacteristics:SpongiosisinepidermiswithperivascularorupperdermalchronicinflammatorycellinfiltratePathophysiology:Unknown,althoughseveraltheoriesincludingtheroleofsexhormonesandabdominalwalldistensioncausedbypregnancy2021/4/27272021/4/27282021/4/2729Prurigoofpregnancy妊娠癢疹

DescribedbyBesnierin1904Incidenceapproximately1in300SimilartonodularprurigoseeninnonpregnantpersonsLikelytobesameeruptionthatSpanglerdescribedaspapulardermatitisofpregnancyPruriticpapulesonextensoraspectsoflimbsandonabdomenNormalmaternalandfetalprognosisHistopathologicfeatures:ChronicinflammatorycellinfiltrateinupperdermiswithoccasionalepidermalfeaturesPathophysiology:Unknown,althoughthoughttobearesultofphysiologicpruritusinwomenwithanatopicbackgroundTreatment:Moderatelypotenttopicalcorticosteroids,antihistaminesPrognosis:Noadverseeffectstomotherorinfant;resolutionpostpartum2021/4/2730Herpesgestationis妊娠皰疹

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