Specific Pregnancy Dermatoses

Abstract and Introduction

Abstract
The specific dermatoses of pregnancy are a rare group of skin diseases specifically related to pregnancy. Diagnostic clues are outlined in a diagrammatic way that can facilitate the recognition between dermatoses of pregnancy in daily dermatology clinic practice.
Introduction
Pregnancy is a physiological status of a woman. Every organ is adapting in order to accept another human body. The main changes occur in the endocrine, immune, metabolic, and vascular systems. The skin is no exception. Many skin changes during pregnancy are considered to be normal or physiological, including striae gravidarum or melasma. These physiological skin changes are usually well tolerated by the pregnant woman. There is no balance between these systems, however, and abnormalities can appear. Immunologic status of the woman plays an important role in the manifestations exhibited in the skin. Alterations of the skin during pregnancy can be classified as physiologic skin changes, changes in pre-existing skin diseases, and specific dermatoses of pregnancy.

The specific dermatoses of pregnancy are a rare group of severely pruritic inflammatory skin diseases related specifically to pregnancy and/or the immediate postpartum period. Clinical diagnosis based on morphologic criteria is still very important for specific dermatoses of pregnancy, because unequivocal diagnostic tests are only available for some of them. Specifically immunofluorescence for pemphigoid gestationis or laboratory investigations for intrahepatic cholestasis of pregnancy are available. The most recent classification of these dermatoses of pregnancy proposed by Ambros-Rudolph, Müllegger, Vaughan-Jones, Kerl, and Black (2006) includes the following diseases:

1. 
   Pemphigoid gestationis (PG) (herpes gestationis).
   
2. 
   Pruritic urticarial papules and plaques of pregnancy (polymorphic eruption of pregnancy, toxic erythema of pregnancy, toxemic rash of pregnancy, late onset prurigo of pregnancy).
   
3. 
   Intrahepatic cholestasis of pregnancy (ICP) (cholestasis of pregnancy, obstetric cholestasis, jaundice of pregnancy, pruritus gravidarum, prurigo gravidarum, icterus gravidarum, cholestatic jaundice of pregnancy).
   
4. 
   Atopic eruption of pregnancy (AEP) (prurigo of pregnancy, prurigo gestationis, pruritic folliculitis of pregnancy, early onset prurigo of pregnancy, eczema in pregnancy).
   

It is necessary to know how to diagnose and treat this condition to establish a better outcome for the mother and the fetus. Interdisciplinary management involving dermatologists, nurse practitioners, obstetricians, and pediatricians is mandatory because some of these conditions (ICP, PG) present a significant risk for the fetus including prematurity, fetal distress, or even stillbirth.