Pruritus can affect up to 20% of women during pregnancy. Pruritus is usually caused by dry skin; however, it can also point to an underlying condition unique to pregnancy.1 Pregnancy is associated with endocrine and immunologic changes, which may contribute to pruritus.2 Common skin conditions during pregnancy include hormone-related, preexisting, and pregnancy-specific. Hormonal changes during pregnancy can cause striae gravidarum (stretch marks), hyper-pigmentation (melasma), as well as hair, nail, and vascular changes.3 The dermatoses of pregnancy include pruritic urticarial papules and plaques of pregnancy (PUPPP), intrahepatic cholestasis of pregnancy (ICP), pemphigoid gestationis (PG), and atopic eruption of pregnancy.1

Striae gravidarum affect nearly 90% of pregnant women by the third trimester. Striae usually present as pink-purple, atrophic lines or bands on the abdomen, buttocks, breasts, thighs, or arms and are a common occurrence in younger women, women with larger babies, and women with higher body mass indices. Striae gravidarum may be associated with itching, burning, and discomfort.4

PUPPP is a benign, self-limited pruritic inflammatory disorder and may also be referred to as polymorphic eruption of pregnancy, toxemia of pregnancy, or prurigo of pregnancy. It presents with urticarial papules coalescing into plaques. The lesions may be seen from the abdomen to the buttocks and thighs. It starts on the abdomen, usually within the striae. Mild to potent topical corticosteroids and antihistamines are often used to treat PUPPP. Oil baths and emollients also help for relief of pruritus.1

ICP is also known as idiopathic jaundice of pregnancy, obstetric cholestasis, and pruritus gravidarum. It manifests in the second or third trimester with sudden onset of severe pruritus begining on the palms and soles and then becomes more generalized. Pruritus continues through the pregnancy and is worst at night. Secondary lesions include linear excoriations and excoriated papules and develop secondary to scratching.1

PG is a self-limited autoimmune disorder that presents after the 20th week of gestation and may only appear in the postpartum period. The rash begins with pruritic, urticarial, erythematous papules and plaques around the umbilicus and extremities. With disease progression, the lesions develop into tense blisters. Commonly, PG flares around the time of delivery.1

Atopic eruption of pregnancy encompasses prurigo of pregnancy, pruritic folliculitis of pregnancy, and eczema in pregnancy. These are benign pruritic conditions of pregnancy that include eczematous or papular lesions in patients with a history of atopy. Most patients develop extensive eczematous changes affecting the face, neck, chest, and the flexures of the extremities. About one-third of the patients have papular lesions.1

Antihistamines and corticosteroids are the commonly prescribed agents to manage pruritic skin conditions in pregnancy.3 Use of a skin lubricant cream at bedtime helps soothe pruritus. Alcohol-free lotions can be used during the day. Topical emollients are safe in pregnancy and can provide slight relief of pruritus.5

References

1. Bergman H, Melamed N, Koren G. Pruritus in pregnancy - Treatment of dermatoses unique to pregnancy. Can Fam Physician. 2013 Dec; 59(12): 1290-1294.
2. Szczęch J, Wiatrowski A, Hirnle L, Reich A. Prevalence and Relevance of Pruritus in Pregnancy. Biomed Res Int. 2017; 2017: 4238139.
3. Tunzi M, Gray GR. Common Skin Conditions During Pregnancy. Am Fam Physician. 2007 Jan 15;75(2):211-218.
4. Farahnik B, Park K, Kroumpouzos G, Murase J. Striae gravidarum: Risk factors, prevention, and management. International Journal of Women’s Dermatology 2017;3(2):77-85.
5. Malhotra J, Agrawal P, Garg R, Malhotra N. Pruritus in Pregnancy. Journal of South Asian Federation of Obstetrics and Gynaecology 2013;5(3):142-146.