妊娠期皮肤病（英文版）.ppt

1、Pregnancy dermatoses,2009.08.11,Physiologic skin changes in pregnancy Dermatoses exacerbated by pregnancy Dermatoses only occurring in pregnancy Specific dermatoses of pregnancy,Physiologic skin changes in pregnancy妊娠期皮肤的生理变化,Hyperpigmentation 色素沉着,Occurs in 90% of pregnant women Increased melanocyt

2、e-stimulating hormone Accentuation on areolae, genital skin, and linea alba Usually regresses postpartum,Melasma 黄褐斑,Occurs in 70% of pregnant women Also seen with oral contraceptivetherapy Centrofacial, malar, and mandibular patterns Excessive melanin in epidermis or dermal macrophages Worsens with

3、 UVB exposure,Hirsutism 多毛症,Face, limbs, and back Regresses within 6 months postpartum Slowed conversion from anagen to telogen hairs,Nail changes 甲改变,Transverse grooving Brittleness Distal onycholysis,Increased eccrine gland activity 内分泌腺活性增加,Miliaria Dyshidrotic eczema Hyperhidrosis,Decreased apoc

4、rine gland activity大汗腺活动性减少,Hidradenitis suppurativa alleviated,Increased sebaceous gland activity 皮脂腺活动性增加,Exacerbation of acne vulgaris Montgomerys tubercles enlarge,Striae distensae妊娠纹,Occur in 90% of pregnant women Pink or purple atrophic longitudinal bands Caused by increased adrenocortical act

5、ivity Fade postpartum to persistent pale atrophic bands,Vascular changes血管变化,Spider nevi Palmar erythema Nonpitting facial edema Venous varicosities: Legs Vasomotor instability Dermographism Edema and hyperemia of gingivae,Dermatoses exacerbated by pregnancy妊娠期加重的皮肤病,Atopic eczema 特应性皮炎,May deterior

6、ate or remit during pregnancy limbs and/or trunk and face May present for the first time in pregnancy in predisposed person Irritant hand dermatitis and nipple eczema common postpartum Treatment: topical corticosteroids, emollients, UVB,Psoriasis 银屑病,Most common type : chronic plaque psoriasis Diffe

7、rential diagnosis of pustular variant from impetigo herpetiformis may be difficult Topical treatment: Dithranol, calcipotriol, tar, and corticosteroids are all safe in pregnancy Systemic drugs: retinoids, methotrexate, and hydroxyurea are all contraindicated in pregnancy. Cyclosporine should be used

8、 with caution during pregnancy and breast-feeding.,Acne vulgaris寻常痤疮Urticaria荨麻疹Lichen planus扁平苔藓,Infections 感染性皮肤病,Viral (herpes simplex, varicella zoster) Bacterial (impetigo, trichomoniasis, leprosy) Fungal (candidal, Pityrosporum folliculitis) AIDS,Lupus erythematosus (LE),Debate continues ：whet

9、her lupus flares are more common in pregnancy. Cutaneous flares are the most common, followed by arthritis. Painful vasculitic lesions on the peripheries are the most common skin lesions. Neonatal LE is seen in babies of mothers with circulating anti-Ro(SSA) antibodies and can lead to congenital hea

10、rt block. The antiphospholipid syndrome presents with thrombosis, recurrent miscarriage, livedo reticularis, migraine, stroke, and/or thrombocytopenia. Treatment with systemic corticosteroids and antimalarials should not be stopped in pregnancy, to prevent an acute flare.,Systemic sclerosisPolymyosi

11、tis/DermatomyositisPemphigus,Cutaneous tumors affected by pregnancy,Pyogenic granuloma Hemangioma Hemangioendothelioma Glomus tumor Dermatofibroma Leiomyoma Keloid Neurofibroma Nevi Melanoma,Dermatoses only occurring in pregnancy仅发生在妊娠期的皮肤病,Impetigo herpetiformis疱疹样脓疱病,Reminiscent of pustular psoria

12、sis, no prior history of psoriasis Associated with hypoparathyroidism and hypocalcemia Systemic upset with malaise, fever, delirium, diarrhea, vomiting, and tetany secondary to hypocalcemia Erythematous patches with pustular margin in flexural distribution Sparing of face, hands, and feet Postinflam

13、matory hyperpigmentation common Histopathologic features identical to pustular psoriasis with spongiform pustules of Kogoj, large collections of neutrophils within foci of spongiotic epidermis Laboratory findings: Elevated leukocyte count and erythrocyte sedimentation rate, hypocalcemia Treatment: P

14、rednisolone 30-40 mg daily Prognosis: Stillbirth and placental insufficiency still frequently seen even when disease is apparently controlled. Remission postpartum but recurrence in successive pregnancies occurs frequently.,Intrahepatic cholestasis of pregnancy妊娠期肝脏内胆汁郁积,Increased incidence Presents

15、 in third trimester with severe intractable pruritus Clinical : Often only excoriations; clinical jaundice rare; mal-absorption of fat can lead to weight loss and vitamin K deficiency in severe cases Usually nonresponsive to antihistamines and topical emollients Histopathologic findings: Skin findin

16、gs nonspecific; liver biopsy specimen will reveal typical changes in severe cases with dilated bile canaliculi, staining of parenchyma with bile pigments and minimal inflammation. These changes are reversible postpartum. Pathophysiology: Associated with HLA subtype B8 and BW16 and positive family hi

17、story in up to 50% of cases. Physiologic concentrations of estrogens thought to interfere with hepatic bile acid secretion Abnormal serum liver function tests (LFTs) and elevated serum bile acids confirm the diagnosis Treatment: Antipruritic emollients, Ion-exchange resins , UVB, evening primrose oi

18、l. Prognosis: Increased rate of fetal distress, stillbirth, and preterm delivery.,Specific dermatoses of pregnancy妊娠特异性皮肤病,Pruritic urticarial papules and plaques of pregnancy (PUPPP)妊娠多形疹,Incidence between 1 in 160 women and 1 in 300 Presents in primiparous women in third trimester or postpartum In

19、creased incidence in multiple pregnancy Rare recurrence in subsequent pregnancies Onset with pruritus within striae on abdomen; periumbilical sparing may occur Clinically characterized by various lesions including erythematous plaques, papules, vesicles, purpura, and erythema multiformelike lesions

20、Subsequent spread to breasts, upper thighs, and arms, sparing face Serologic and immunofluorescence tests negative Subtype described in which IgM deposition seen either on direct or indirect immunofluorescence Histopathologic characteristics: Spongiosis in epidermis with perivascular or upper dermal

21、 chronic inflammatory cell infiltrate Pathophysiology: Unknown, although several theories including the role of sex hormones and abdominal wall distension caused by pregnancy,Prurigo of pregnancy妊娠痒疹,Described by Besnier in 1904 Incidence approximately 1 in 300 Similar to nodular prurigo seen in non

22、pregnant persons Likely to be same eruption that Spangler described as papular dermatitis of pregnancy Pruritic papules on extensor aspects of limbs and on abdomen Normal maternal and fetal prognosis Histopathologic features: Chronic inflammatory cell infiltrate in upper dermis with occasional epide

23、rmal features Pathophysiology: Unknown, although thought to be a result of physiologic pruritus in women with an atopic background Treatment: Moderately potent topical corticosteroids, antihistamines Prognosis: No adverse effects to mother or infant; resolution postpartum,Herpes gestationis 妊娠疱疹,Aut

24、oimmune bullous disorder, closely related to bullous pemphigoid (BP) Rare with incidence of approximately 1 in 60,000 Onset usually in second and third trimester or postpartum period Recurrence common in subsequent pregnancy at earlier gestation and with increased severity (apart from skip pregnanci

25、es, which occur when a woman with known PG has a subsequent unaffected pregnancy) Pruritic erythematous plaques, which become annular or polycyclic, developing into vesicles or bullae Periumbilical involvement in 87% of cases Transplacental transfer of antibodies can result in neonatal involvement A

26、ssociated with low birth weight and premature birth caused by placental insufficiency Histopathologic features: Similar to PEP in early phases; subepidermal separation with basal cell necrosis; eosinophilic spongiosis Immunofluorescence diagnostic test: Positive direct immunofluorescence with IgG and complement 3 staining at the basement membrane zone and staining to the roof on indirect immunofluorescence using salt-split skin Pathophysiology: HLA-DR3, DR4 subtypes associated; close relationship to BP, sharing same target antigen BP-180 kd (BP-AG2), a compo