妊娠期皮肤病.ppt

Pregnancydermatoses,2009.08.11,PhysiologicskinchangesinpregnancyDermatosesexacerbatedbypregnancyDermatosesonlyoccurringinpregnancySpecificdermatosesofpregnancy,Physiologicskinchangesinpregnancy妊娠期皮肤的生理变化,Hyperpigmentation色素沉着,Occursin90%ofpregnantwomenIncreasedmelanocyte-stimulatinghormoneAccentuationonareolae,genitalskin,andlineaalbaUsuallyregressespostpartum,Melasma黄褐斑,Occursin70%ofpregnantwomenAlsoseenwithoralcontraceptivetherapyCentrofacial,malar,andmandibularpatternsExcessivemelanininepidermisordermalmacrophagesWorsenswithUVBexposure,Hirsutism多毛症,Face,limbs,andbackRegresseswithin6monthspostpartumSlowedconversionfromanagentotelogenhairs,Nailchanges甲改变,TransversegroovingBrittlenessDistalonycholysis,Increasedeccrineglandactivity内分泌腺活性增加,MiliariaDyshidroticeczemaHyperhidrosis,Decreasedapocrineglandactivity大汗腺活动性减少,Hidradenitissuppurativaalleviated,Increasedsebaceousglandactivity皮脂腺活动性增加,ExacerbationofacnevulgarisMontgomerystuberclesenlarge,Striaedistensae妊娠纹,Occurin90%ofpregnantwomenPinkorpurpleatrophiclongitudinalbandsCausedbyincreasedadrenocorticalactivityFadepostpartumtopersistentpaleatrophicbands,Vascularchanges血管变化,SpiderneviPalmarerythemaNonpittingfacialedemaVenousvaricosities:LegsVasomotorinstabilityDermographismEdemaandhyperemiaofgingivae,Dermatosesexacerbatedbypregnancy妊娠期加重的皮肤病,Atopiceczema特应性皮炎,Maydeteriorateorremitduringpregnancylimbsand/ortrunkandfaceMaypresentforthefirsttimeinpregnancyinpredisposedpersonIrritanthanddermatitisandnippleeczemacommonpostpartumTreatment:topicalcorticosteroids,emollients,UVB,Psoriasis银屑病,Mostcommontype:chronicplaquepsoriasisDifferentialdiagnosisofpustularvariantfromimpetigoherpetiformismaybedifficultTopicaltreatment:Dithranol,calcipotriol,tar,andcorticosteroidsareallsafeinpregnancySystemicdrugs:retinoids,methotrexate,andhydroxyureaareallcontraindicatedinpregnancy.Cyclosporineshouldbeusedwithcautionduringpregnancyandbreast-feeding.,Acnevulgaris寻常痤疮Urticaria荨麻疹Lichenplanus扁平苔藓,Infections感染性皮肤病,Viral(herpessimplex,varicellazoster)Bacterial(impetigo,trichomoniasis,leprosy)Fungal(candidal,Pityrosporumfolliculitis)AIDS,Lupuserythematosus(LE),Debatecontinues：whetherlupusflaresaremorecommoninpregnancy.Cutaneousflaresarethemostcommon,followedbyarthritis.Painfulvasculiticlesionsontheperipheriesarethemostcommonskinlesions.NeonatalLEisseeninbabiesofmotherswithcirculatinganti-Ro(SSA)antibodiesandcanleadtocongenitalheartblock.Theantiphospholipidsyndromepresentswiththrombosis,recurrentmiscarriage,livedoreticularis,migraine,stroke,and/orthrombocytopenia.Treatmentwithsystemiccorticosteroidsandantimalarialsshouldnotbestoppedinpregnancy,topreventanacuteflare.,SystemicsclerosisPolymyositis/DermatomyositisPemphigus,Cutaneoustumorsaffectedbypregnancy,PyogenicgranulomaHemangiomaHemangioendotheliomaGlomustumorDermatofibromaLeiomyomaKeloidNeurofibromaNeviMelanoma,Dermatosesonlyoccurringinpregnancy仅发生在妊娠期的皮肤病,Impetigoherpetiformis疱疹样脓疱病,Reminiscentofpustularpsoriasis,nopriorhistoryofpsoriasisAssociatedwithhypoparathyroidismandhypocalcemiaSystemicupsetwithmalaise,fever,delirium,diarrhea,vomiting,andtetanysecondarytohypocalcemiaErythematouspatcheswithpustularmargininflexuraldistributionSparingofface,hands,andfeetPostinflammatoryhyperpigmentationcommonHistopathologicfeaturesidenticaltopustularpsoriasiswithspongiformpustulesofKogoj,largecollectionsofneutrophilswithinfociofspongioticepidermisLaboratoryfindings:Elevatedleukocytecountanderythrocytesedimentationrate,hypocalcemiaTreatment:Prednisolone30-40mgdailyPrognosis:Stillbirthandplacentalinsufficiencystillfrequentlyseenevenwhendiseaseisapparentlycontrolled.Remissionpostpartumbutrecurrenceinsuccessivepregnanciesoccursfrequently.,Intrahepaticcholestasisofpregnancy妊娠期肝脏内胆汁郁积,IncreasedincidencePresentsinthirdtrimesterwithsevereintractablepruritusClinical:Oftenonlyexcoriations;clinicaljaundicerare;mal-absorptionoffatcanleadtoweightlossandvitaminKdeficiencyinseverecasesUsuallynonresponsivetoantihistaminesandtopicalemollientsHistopathologicfindings:Skinfindingsnonspecific;liverbiopsyspecimenwillrevealtypicalchangesinseverecaseswithdilatedbilecanaliculi,stainingofparenchymawithbilepigmentsandminimalinflammation.Thesechangesarereversiblepostpartum.Pathophysiology:AssociatedwithHLAsubtypeB8andBW16andpositivefamilyhistoryinupto50%ofcases.PhysiologicconcentrationsofestrogensthoughttointerferewithhepaticbileacidsecretionAbnormalserumliverfunctiontests(LFTs)andelevatedserumbileacidsconfirmthediagnosisTreatment:Antipruriticemollients,Ion-exchangeresins,UVB,eveningprimroseoil.Prognosis:Increasedrateoffetaldistress,stillbirth,andpretermdelivery.,Specificdermatosesofpregnancy妊娠特异性皮肤病,Pruriticurticarialpapulesandplaquesofpregnancy(PUPPP)妊娠多形疹,Incidencebetween1in160womenand1in300PresentsinprimiparouswomeninthirdtrimesterorpostpartumIncreasedincidenceinmultiplepregnancyRarerecurrenceinsubsequentpregnanciesOnsetwithprurituswithinstriaeonabdomen;periumbilicalsparingmayoccurClinicallycharacterizedbyvariouslesionsincludingerythematousplaques,papules,vesicles,purpura,anderythemamultiformelikelesionsSubsequentspreadtobreasts,upperthighs,andarms,sparingfaceSerologicandimmunofluorescencetestsnegativeSubtypedescribedinwhichIgMdepositionseeneitherondirectorindirectimmunofluorescenceHistopathologiccharacteristics:SpongiosisinepidermiswithperivascularorupperdermalchronicinflammatorycellinfiltratePathophysiology:Unknown,althoughseveraltheoriesincludingtheroleofsexhormonesandabdominalwalldistensioncausedbypregnancy,Prurigoofpregnancy妊娠痒疹,DescribedbyBesnierin1904Incidenceapproximately1in300SimilartonodularprurigoseeninnonpregnantpersonsLikelytobesameeruptionthatSpanglerdescribedaspapulardermatitisofpregnancyPruriticpapulesonextensoraspectsoflimbsandonabdomenNormalmaternalandfetalprognosisHistopathologicfeatures:ChronicinflammatorycellinfiltrateinupperdermiswithoccasionalepidermalfeaturesPathophysiology:Unknown,althoughthoughttobearesultofphysiologicpruritusinwomenwithanatopicbackgroundTreatment:Moderatelypotenttopicalcorticosteroids,antihistaminesPrognosis:Noadverseeffectstomotherorinfant;resolutionpostpartum,Herpesgestationis妊娠疱疹,Autoimmunebullousdisorder,closelyrelatedtobullouspemphigoid(BP)Rarewithincidenceofapproximately1in60,000OnsetusuallyinsecondandthirdtrimesterorpostpartumperiodRecurrencecommoninsubsequentpregnancyatearliergestationandwithincreasedseverity(apartfromskippregnancies,whichoccurwhenawomanwithknownPGhasasubsequentunaffectedpregnancy)Pruriticerythematousplaques,whichbecomeannularorpolycyclic,developingintovesiclesorbullaePeriumbilicalinvolvementin87%ofcasesTransplacentaltransferofantibodiescanresultinneonatalinvolvementAssociatedwithlowbirthweightandprematurebirthcausedbyplacentalinsufficiencyHistopathologicfeatures:SimilartoPEPinearlyphases;subepidermalseparationwithbasalcellnecrosis;eosinophilicspongiosisImmunofluorescencediagnostictest:PositivedirectimmunofluorescencewithIgGandcomplement3stainingatthebasementmembranezoneandstainingtotheroofonindirectimmunofluorescenceusingsalt-splitskinPathophysiology:HLA-DR3,DR4subtypesassociated;closerelationshiptoBP,sharingsametargetantigenBP-180kd(BP-AG2),