妊娠期皮肤病PPT课件.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 ExacerbationofacnevulgarisMontgomery stuberclesenlarge 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 anderythemamultiforme likelesionsSubsequentspreadtobreasts 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