Pruritus affects nearly 20% of pregnant women. Pruritus can be severe enough to affect sleep and quality of life, and might also lead to, or worsen, depression. Pruritus is commonly caused by dry skin; however it can also suggest an underlying condition unique to pregnancy. 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

PUPPP is a benign, self-limited pruritic inflammatory disorder. It is also known as polymorphic eruption of pregnancy (PEP), toxemia of pregnancy, or prurigo of pregnancy. PUPPP usually presents with urticarial papules that form plaques and spread from the abdomen to the buttocks and thighs.1 Intrahepatic cholestasis of pregnancy, also called idiopathic jaundice of pregnancy, obstetric cholestasis, and pruritus gravidarum, occurs as a result of disruption of hepatic bile flow during pregnancy. It usually presents in the second or third trimester and is marked by sudden onset of severe pruritus that starts on the palms and soles and becomes more generalized. The pruritus persists throughout pregnancy and is usually worse at night. Secondary lesions involve linear excoriations and excoriated papules and develop after scratching.1 Pemphigoid gestationis is a self-limited autoimmune bullous disorder often presenting after the 20th week of gestation. There is intense pruritus that may precede the skin lesions. Initially, there are pruritic, urticarial, erythematous papules and plaques around the umbilicus and extremities that may develop into blisters.1 Atopic eruption of pregnancy encompasses prurigo of pregnancy, pruritic folliculitis of pregnancy, and eczema in pregnancy. These benign pruritic conditions of pregnancy present with eczematous or papular lesions in patients with a history of atopy.1

An Indian study evaluated the frequency and pattern of skin changes in pregnant women. In all, 607 pregnant women were included in the study. Of these, 303 (49.9%) pregnant women were primigravida and 304 (51.1%) were multigravida. Skin changes were categorized as physiological changes (all cases), specific dermatoses (22 cases) and other dermatoses affected by pregnancy (125 cases). Most common physiological changes were pigmentary alterations seen in 91.4% women followed by striae seen in 79.7% cases. Among the specific dermatoses of pregnancy, PUPPP was the most common disorder (14 cases) followed by pruritus gravidarum (5 cases). The most common dermatoses affected by pregnancy included candidal vaginitis (17 cases), acne vulgaris (15 cases), skin tags (15 cases), eczemas (14 cases).2

It is thus evident that pregnancy is a period of intense immunologic, metabolic, endocrine and vascular changes, thus making the pregnant woman susceptible to changes in the skin and appendages, which can be both physiologic and pathologic. These changes may range from normal cutaneous changes, to common skin conditions that are not associated with pregnancy, to eruptions that are specifically associated with pregnancy.2

It is important to distinguish between physiological skin changes and specific dermatoses of pregnancy for improved patient care.

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. Kumari R, Jaisankar T J, Thappa DM. A clinical study of skin changes in pregnancy. Indian J Dermatol Venereol Leprol 2007;73:141.