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A clinical study of skin changes in pregnancy

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A clinical study of skin changes in pregnancy

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During pregnancy profound immunologic, metabolic, endocrine and vascular changes occur, that are responsible for the changes of the skin and its appendages, both physiologic and pathologic. We undertook a clinical study to find out the frequency and pattern of skin changes in pregnant women. All consecutive pregnant women were included in the study. A total of 607 pregnant women were included in this study. Of these, 303 (49.9%) pregnant women were primigravida and 304 (51.1%) were multigravida. Skin changes grouped into: 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 555 (91.4%) followed by striae seen in 484 (79.7%) cases. Of the various specific dermatoses of pregnancy, pruritic urticarial papules and plaques of pregnancy (PUPPP) was the most common disorder (14 cases) followed by pruritus gravidarum (5 cases). The most common dermatoses affected by pregnancy were candidal vaginitis (17 cases), acne vulgaris (15 cases), skin tags (15 cases), eczemas (14 cases). This study brings into focus various skin changes during pregnancy in south India.
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A clinical study of skin changes in pregnancy
A clinical study of skin changes in pregnancy
Rashmi Kumari, T. J. Jaisankar, Devinder Mohan Thappa
Rashmi Kumari, T. J. Jaisankar, Devinder Mohan Thappa
Department of Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry - 605 006,
India.
ABSTRACT
Address for correspondence
Address for correspondence: Dr. Devinder Mohan Thappa, Department of Dermatology and STD, JIPMER, Pondicherry - 605 006, India.
E-mail- dmthappa@satyam.net.in
Background: During pregnancy profound immunologic, metabolic, endocrine and vascular changes occur, that are
responsible for the changes of the skin and its appendages, both physiologic and pathologic. Aims: We undertook
a clinical study to find out the frequency and pattern of skin changes in pregnant women. Methods: All consecutive
pregnant women were included in the study. Results: A total of 607 pregnant women were included in this study. Of
these, 303(49.9%) pregnant women were primigravida and 304(51.1%) were multigravida. Skin changes grouped into:
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 555 (91.4%) followed by striae seen in
484(79.7%) cases. Of the various specific dermatoses of pregnancy, pruritic urticarial papules and plaques of pregnancy
(PUPPP) was the most common disorder (14 cases) followed by pruritus gravidarum (5 cases). The most common
dermatoses affected by pregnancy were candidal vaginitis (17 cases), acne vulgaris (15 cases), skin tags (15 cases),
eczemas (14 cases). Conclusion: This study brings into focus various skin changes during pregnancy in south India.
Key Words: Physiologic changes, Pregnancy dermatoses, Specific dermatoses
INTRODUCTION
INTRODUCTION
study to know the frequency and pattern of skin changes in
pregnant women and various clinical parameters affecting
During pregnancy profound immunologic, metabolic,
them in south India.
endocrine and vascular changes occur, which make the
pregnant woman susceptible to changes of the skin and
METHODS
METHODS
appendages, both physiologic and pathologic.
[1]
These
alterations may range from normal cutaneous changes that
The study was conducted in the out-patient department
occur with almost all pregnancies, to common skin diseases
that are not associated with pregnancy, to eruptions that
appear to be specifically associated with pregnancy. Likewise,
the concerns of the patient may range from cosmetic
appearance, to the chance of recurrence of the particular
problem during a subsequent pregnancy, to its potential
effects on the fetus in terms of morbidity and mortality.
[2]
Moreover, pregnancy modifies the course of a number of
preexisting dermatological conditions.
[3]
We undertook this
of Obstetrics and Gynecology, JIPMER, Pondicherry. Ethical
committee clearance was obtained. All pregnant women seen
between September 2003 and June 2005 were included in the
study irrespective of the duration of pregnancy and gravidity.
Informed consent was obtained before the interview and
clinical examination. A total of 607 pregnant women were
included in the study. Detailed history including demographic
data, chief complaints related to skin, presence of itching,
skin lesions, onset in relation to duration of pregnancy,
How to
o
cite this article
How t cite this article: Kumari R, Jaisankar TJ, Thappa DM. A clinical study of skin changes in pregnancy. Indian J Dermatol Venereol Leprol
2007;73:141.
R
R
eceived:
ccepted: March, 2007.
Source of Support:
Con ict of interest: None declared. eceived: June, 2006.
A
A
ccepted:
Source of Support: Nil.
Con
ict of interest:
Indian J Dermatol Venereol Leprol|March-April 2007|Vol 73|Issue 2152
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jaundice, vaginal discharge, past or family history of similar
lesions, exacerbating factors, associated medical or skin
disorders etc. was elicited and recorded.
Complete cutaneous examination was done in all cases
to study all the physiological changes of skin and its
appendages. If any specific dermatosis of pregnancy was
present, the morphology of skin lesions, distribution and the
sites involved were studied. Relevant systemic examination
was carried out. If any preexisting skin disease was present,
204 multi gravidas. None of them had used oral contraceptive
pills. A history of extramarital sexual exposure was obtained
in 2 pregnant women and six of their respective partners.
PHYSIOLOGICAL SKIN CHANGE
PHYSIOLOGICAL SKIN CHANGES
Among the physiological skin changes observed, most
common were pigmentary changes in 555 (91.4%) cases
including hyperpigmentation of skin, melasma, linea nigra,
development of secondary areola followed by striae in 484
any evidence of exacerbation or remission was recorded.
(79.7%) cases [Table 1].
Appropriate investigations were done to confirm diagnosis if
SPECIFIC DERMAT
T
OSES OF PREGNANC
SPECIFIC DERMA OSES OF PREGNANCY
required. Bedside laboratory procedures like Tzanck smear,
KOH mount and Gram’s stain were carried out. To confirm
Out of 607 pregnant women seen during the study, 22 pregnant
diagnosis skin biopsy and DIF were done in a few cases. In
women had specific dermatoses of pregnancy [Table 2].
all cases with history of pruritus related to specific disorders
of pregnancy, liver function tests were done. Screening with
Pruritic urticarial papules and plaques of pregnancy
VDRL and ELISA for HIV was done in all the cases. Examination
(PUPPP)
of the ‘contact’ was done in all cases of sexually transmitted
In this study, 14 pregnant women were found to have pruritic
disease. Results were tabulated and analyzed.
Table 1: Physiological changes in pregnancy
A total of 607 pregnant women were recruited in our study
from September 2003 to June 2005. Of these, 303 (49.9%)
were primi gravidas and 304 (51.1%) were multi gravidas.
Their age range was 18 to 36 years with a mean of 23 years.
Most of them presented in the second (139 cases, 22.9%) or
third trimester (444 cases, 73.1%). Most of them (597 cases,
98.4%) were native of South India and majority belonged to
skin type IV (425 cases,70%) and V (182 cases,30%).
Pregnancy dermatoses were divided into three categories
Physiological skin changes
Specific dermatoses of pregnancy
Skin diseases affected by pregnancy
RESULT
TSRESUL
Physiological changes seen No. of
cases
Percentage
of cases
Pigmentation
Linea nigra 555 91.4%
Secondary areola 476 78.4%
Melasma 15 2.5%
LSCS scar pigmentation 13 2.1%
Naevi darkening 2 0.33%
Pigmentary demarcation line 2 0.33%
Striae 484 79.7%
Hair changes
Increased hair loss 11 1.8%
Improvement in hair growth
Glandular
5 0.82%
Montgomery’s tubercles 220 36.2%
Miliaria
Vascular
10 1.65%
Non pitting edema of feet 59 9.7%
Abdominal wall edema 3 0.49%
Varicosities of legs 2 0.33%
Vulval edema 3 0.49%
Spider telangiectasias
Mucosal
2 0.33%
Jacquemier-Chadwick sign
Goodell’s sign
Gingivitis
Nail changes
607
607
9
4
100%
100%
1.5%
0.66%
Physiological changes were seen in all cases (607). Twenty two
cases of specific dermatoses of pregnancy were seen. Other
dermatoses affected by pregnancy were seen in 125 cases.
Majority of these pregnant women 546 (89.9%) had no skin
related complaints. In those who had primary complaints,
itching was the most common primary complaint (68, 11.2%)
followed by complaints of presence of skin lesions (52, 8.6%),
vaginal discharge (19, 3.1%), melasma (15, 2.5%), miliaria (10,
1.6%) and vulval growth (3, 0.5%).
Past history of striae and pigmentary changes was observed in
Note: LSCS-Lower segment caesarean section
Table 2: Specic disorders of pregnancy
Specic dermatoses of pregnancy Number Percentage
PUPPP 14 63.6
Pruritus gravidarum 5 22.7
Pemphigoid gestationis 1 4.5
Prurigo gestationis of Besnier 1 4.5
Pruritic folliculitis 1 4.5
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urticarial papules and plaques of pregnancy (PUPPP). Of
these fourteen, 12 (85.7%) were primigravidas and 2 were
multi gravidas (14.3%). One patient had fetal complications
with IUGR and preterm delivery of a male infant weighing
2.2 kgs.
Pruritus gravidarum
Five cases of pruritus gravidarum were seen in this study. Of
these five, three (60%) were primi gravidas and 2 were multi
gravidas (40%). Liver function tests were normal except for
polymorphous light eruption (7 cases), latent syphilis (4
cases), molluscum contagiosum (one case), leprosy (one case),
seborrheic keratoses (2 cases), retracted nipple (4 cases), Café
au lait macule (4 cases), accessory nipple, nevus achromicus
and nevus of Ota (one case each) did not show any change.
DISCUSSION
DISCUSSION
Many of the symptoms and signs are so common that they
are not usually considered as being abnormal, but regarded
Inammatory disorders
Diseases No. of cases Course
Atopic dermatitis
Eczemas
4 No change
Discoid 5 Exacerbated
Pompholyx 2 New onset
PMLE 7 No change
Acne vulgaris
Psoriasis 1
12
1
Exacerbated
Exacerbated
Remission
.medknow.com).
Infections
2 No change
Fungal
Candidal vaginitis 17 New onset
Tinea versicolor 11 New onset
Tinea corporis 5 New onset
Pityrosporum folliculitis
Bacterial vaginosis
Condyloma acuminata
Latent syphilis
HIV infection
2
2
3
4
2
New onset
New onset
Exacerbated
No change
Repeated abortions
(www
Herpes labialis
Herpes genitalis
Molluscum contagiosum
Verruca vulgaris
Leprosy (BT)
Tumors
1
2
1
2
1
12
to other studies.
[4,6,7]
New onset
Exacerbated
No change
Exacerbated
No change
New onset
Skin tags 3 Exacerbated
Neurobromatosis 1 Exacerbated
Seborrhoeic keratoses 2 No change
Melanocytic nevus 2 Exacerbation
Keloids 1 New onset
Autoimmune
Vitiligo 1 New onset
SLE 1 Exacerbation
Pemphigus 1 New onset
Ichthyosis vulgaris 1 Exacerbation
Miscellaneous
Retracted nipple 4 New onset
Accessory nipple 1 No change
Navus achromicus 1 No change
Café au lait macule 4 No change
Nevus of Ota 1 No change
Milia en plaque 1 New onset
raised alkaline phosphatase in 3 patients (60%). No adverse
as physiological and can sometimes provide contributory
fetal outcome was seen in the five pregnant women.
evidence of pregnancy. The commonly encountered
physiological changes include striae distensae (occurring in up
DERMAT
T
OSES AFFECTED BY
Y
PREGNANCY [TABLE 3]
PREGNANCY [TABLE 3]
to 90% of pregnant women), hormonal alterations resulting in
DERMA OSES AFFECTED B
melasma (occurring in up to 75% of women during pregnancy)
Certain dermatoses like atopic dermatitis (4 cases),
and generalized hyperpigmentation. Vascular alterations result
in edema, palmar erythema, spider nevi, varicosities, cutis
Table 3: Skin diseases affected by pregnancy
marmorata, gingival edema and redness. Some women also
notice hair and nail changes. Similarly the activity of eccrine
and sebaceous glands increases, while that of apocrine gland
decreases.
[4]
In addition, pregnancy can modify a number of
concomitant dermatoses and there are some pathological skin
conditions that are virtually pregnancy specific.
The most common physiological changes are pigmentary
alterations, stretch marks, vascular spiders and telogen
effluvium.
[5]
In our study, 91.4% of cases had hyperpigmentation,
the most common being linea nigra seen in 91.4% cases.
Secondary areola developed in 78.4% cases. The other
sites of increased localized pigmentation were seen over
the abdomen, face, buttocks, scar pigmentation, breasts,
axillae, neck in that order. Generalized darkening of skin was
reported in 4 (0.66%) cases. These findings are comparable
Type b pigmentary demarcation lines are known to appear
for the first time during pregnancy.
[8]
James et al.
[9]
in their
study found 7 pregnant women who developed pigmentary
demarcation line for the first time on the posteromedial
aspect of lower limb. In our study, one woman developed
pigmentary demarcation lines on the posterior aspect of
lower limbs for the first time. Another woman reported it for
the first time on the medial aspect of both forearms.
Melasma was seen in 15/607 (2.5%) of our cases. It has been
reported to occur in 50-75% of pregnant women.
[10]
The onset
in 12 (80%) cases was in the first trimester whereas Martin and
Leal-Khouri
[5]
reported an onset of melasma mostly during
the second trimester. Wong and Ellis
[11]
reported melasma
in 50-70 % of pregnant women with an onset during the 2nd
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trimester. Of these, 72% cases were epidermal, 13% dermal
and 5% were of the mixed type. In 30 % of cases, melasma
tends to persist post partum.
[10]
Muzaffer et al
[4]
found
melasma to be present in 65 (46.4%)of their cases. Raj et al
[6]
observed melasma in 10/1175 (8.5%) cases, which is closer
to what is seen in our study. This difference may be due to
the fact that pigmentary changes are more discernible in the
fair skinned individuals.
Striae distensae (striae gravidarum) develop in up to 90% of
proliferation of vessels and regress postpartum. Non pitting
edema of legs, eyelids, face and hands is present in about 50%
of women during the third trimester.
[10]
The edema decreases
during the day and is thought to be due to secondary sodium
and water retention in conjunction with increased capillary
permeability.
[5]
Vascular changes seen in our study include
nonpitting edema of feet in 59 (9.8%) cases and abdominal
wall edema in 3 cases.
Vascular spiders (spider angiomas, nevi aranei) appear in 67%
women during the sixth and seventh month of pregnancy.
[1]
of white and 11% of black women between the 2nd and 5th
In our study, striae were seen in 484 (79.7%) cases of which month of pregnancy. Palmar erythema occurs in 66% of white
217 (44.8%) were primi gravidas and 267 (55.2%) were multi and 33% of black women beginning in first trimester.
[5]
No
gravidas. Onset was most commonly seen during the second
cases of palmar erythema were seen in our study which may
trimester. The most common site seen in primigravidas was
be related to less visibility in darker skin. In a recent study by
lower abdomen and pink shiny striae were most common.
Muzaffar et al.,
[4]
palmar erythema was seen in 12.1% of cases,
Multi gravidas showed mostly white atrophic striae. Muzaffar varicosities of lower legs in 2.8%, vascular spiders in 1.4% and
[4]
found 77.1% (108/140) of their cases developed striae cutis marmorata in 0.7% cases. Varicosities are most common
gravidarum. Raj et al.
[6]
also found striae distensae in 75% of
in anus and legs, appearing in 40% of pregnant women during
pregnant women which is closer to that seen in our study.
the 3rd trimester.
[10]
Raj et al.
[6]
noted varicose veins in 6 out
[12]
found incidence of striae gravidarum in their of 1,175 women. Esteve et al.
[7]
observed vascular changes
survey to be 55%. in 50 women including vascular spiders in 32 out of the 60
women.
Striae are uncommon in Asian and African-American women
and there seems to be a familial tendency.
[1]
Physical factors During pregnancy, the gingivae enlarge, darken and become
(stretching secondary to increase in the abdominal girth) red and swollen in up to 80% of women. Edema and hyperemia
play a role in the development of the striae.
[11,13]
Lower due to hormonal changes as well as local irritation and
birth weight and smaller babies as compared to Caucasian nutritional deficiencies may be responsible.
[5]
Gingivitis not
women may be related to 123/607 (20.3%) pregnant women attributable to bad oral hygiene was seen in 9 out of 607
not developing striae in our study. Poindevin et al.
[14]
in 1959, pregnant women. In a study by Muzaffar et al.
observed that women with lighter complexions had a greater had gingival edema and redness. Raj et al.
tendency to develop striae compared with women of darker of pyogenic granulomas in their study.
complexions.
Specific dermatoses of pregnancy are almost always associated
Of the 607 women, 11 gave a history of increased hair loss with pruritus and an eruption of variable severity. Holmes
and only 5 patients noticed lengthening and improvement and Black
[15]
proposed a simplified clinical classification of
in their scalp hair, whereas 591 (97.4%) gave history of no the specific dermatoses of pregnancy. This classification
et al.
Chang et al.
[4]
23/140 (16.4%)
[6]
had seen 3 cases
change in hair density. Muzaffar et al.
[4]
reported hair changes
in 18 (12.8%) cases. Out of those 18 cases, diffuse thinning of
scalp hair was noted in 7 (38.9%) cases. Nine (50%) patients
noticed lengthening and improvement in their scalp hair.
Frontoparietal recession and hypertrichosis was seen in one
case each.
Increased appearance of Montgomery’s tubercles is well
known during pregnancy in 30-50% of pregnant women.
[5]
In
our study, Montgomery’s tubercles were seen in 220 (36.3%)
cases. This was found to be consistent with other studies.
[5]
Vascular changes result from distention, instability and
basically subdivided the specific dermatoses of pregnancy
into four groups: (i) pemphigoid (herpes) gestationis (PG);
(ii) polymorphic eruption of pregnancy (PEP); (iii) prurigo of
pregnancy; and (iv) pruritic folliculitis of pregnancy (PF).
[15]
The incidence of these specific disorders of pregnancy is 0.5
to 3.0%.
[16]
In our study of 607 pregnant women, 22 (3.6%)
cases of specific dermatoses of pregnancy were seen. Of these
the most common was PUPPP (also known as polymorphic
eruption of pregnancy) with a total of 63.6% (14/22) cases
followed by 5 (22.7%) cases of pruritus gravidarum. In an
Indian study, Shivakumar and Madhavamurthy
[17]
found
pruritus to be the commonest symptom (58.82%). Candidiasis
(21.78%) was the commonest cause of white discharge per
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vagina, Condylomata acuminata (4.70%) was the commonest
sexually transmitted disease. Of the disorders specific to
pregnancy, 16 (9.41%) had prurigo of pregnancy, 6 (3.52%) had
pruritus gravidarum and 4 (2.35%) had polymorphic eruption
of pregnancy.
This study brings into focus various skin changes during
pregnancy. Clinicians need to distinguish between
physiological skin changes and specific dermatoses of
pregnancy for better patient care.
Indian J Dermatol Venereol Leprol 1992;58:84-8.
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Physiological cutaneous signs in normal pregnancy: A study of
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... [3] Estrogen, augmented by progesterone, stimulates melanin production. [4,5,6] It activates intracellular oestrogen α-and β-receptors in the skin, stimulating melanocytes to increase melanin output. [6] Gynecomastia is the enlargement of the breast in a male. ...
... [4,5,6] It activates intracellular oestrogen α-and β-receptors in the skin, stimulating melanocytes to increase melanin output. [6] Gynecomastia is the enlargement of the breast in a male. It is usually due to hormonal imbalance and is typically. ...
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Background: Linea nigra and gynaecomastia are presumably markers of estrogen function and impaired androgen receptor activity in certain disease conditions. Since prostate cancer (PCa) is androgen-dependent, Linea nigra (LN) and gynaecomastia could be potentially non-invasive modalities used in the risk assessment of patients during screening and diagnosis for prostate cancer. Objectives: This study aims to determine the relationship between prostate cancer with Linea nigra and gynaecomastia. Methods: This is a comparative descriptive cross-sectional study on forty patients, twenty with benign prostatic enlargement (BPE) and twenty with PCa, who presented to the urology outpatient department or were admitted to the urology ward of the hospital. A proforma data collection sheet collated demographic information, clinical presentation, prostate-specific antigen (PSA) levels, and Linea nigra and gynecomastia presence. The data obtained were analyzed using the SPSS Version 25 software. Chi-square and Spearman's Rank analysis was used to test for association and relationship at a 95% confidence interval, with a p< 0.05 was considered significant. Results: The mean age was 71.0250 ± 11.01years, ranging from 39 to 96years. Linea nigra was seen in two (5%) and absent in thirty-eight (95%) of all the patients. The modal age range was the 70-79-year group, and none had linea nigra. Gynaecomastia was seen in four (10%) and absent in thirty-six (90%) of the patients. One patient in the age range of 50-59years, two in the 60-69years range and one in the 80-89 age range had gynaecomastia. A patient with BPE and three with PCa had gynaecomastia. There was no statistically significant association or relationship between gynaecomastia and prostate cancer. There was a significant association between gynaecomastia and PSA (p=0.008) but none between PSA and Linea nigra. Conclusion: Our study shows no statistically significant association between Linea nigra and gynaecomastia with prostate cancer. There is an association between gynaecomastia and PSA that require further evaluation. More extensive studies are needed to elucidate any relationships.
... Kumari R et al in their clinical study on skin changes in pregnancy found that pigmentary changes were the most common physiological changes, seen in nearly 91% of pregnant ladies whereas generalized darkening of skin was reported in 0.66% cases. [4] The exact pathogenesis for hyperpigmentation and its distribution remain elusive till date and evades complete explanation. Hyperpigmentation in pregnancy is attributed to an increased level of placental, pituitary, and ovarian hormones namely, melanocyte stimulating hormone, oestrogen, progesterone, and bioactive sphingolipids derived from the placenta. ...
... Hyperpigmentation in pregnancy is attributed to an increased level of placental, pituitary, and ovarian hormones namely, melanocyte stimulating hormone, oestrogen, progesterone, and bioactive sphingolipids derived from the placenta. [1][2][3][4][5][6] Blood levels of progesterone depict a constant increment during pregnancy. Blood levels of oestrogen rises from the 8th week and begins to decline after the 30th week of pregnancy. ...
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Hyperpigmentation during pregnancy is commonly due to endocrinological changes. The pigmentation generally fades away in a few months post-partum. However sometimes it may persist for longer periods causing distress to the patient. Here we report one such case where the pigment persisted for more than a year.
... 10 Kumari et al reported 14 cases of polymorphic eruption of pregnancy and 5 cases of intrahepatic cholestasis of pregnancy. 9 A study by Puri et al showed that polymorphic eruption of pregnancy caused 22% of cases, prurigo of pregnancy caused 7% of cases, pemphigoid gestationis caused 3% of cases, pruritic folliculitis caused 2% of cases, and intrahepatic cholestasis caused 1% of cases. 11 In our study, we found an increased incidence of infection during pregnancy, which is associated with low cellular immunity (Table 8). ...
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p class="abstract"> Background: Women undergo profound changes during pregnancy, making them susceptible to a number of dermatological manifestations. We aimed to determine the frequency and pattern of skin changes during pregnancy. Methods: A cross-sectional observational study was conducted among 400 pregnant women presenting to the Outpatient department of a Tertiary Care Centre in Northern India. Results: A total of 400 pregnant mothers fulfilling inclusion criteria were included. The pigmentary changes were the most common physiological change seen in 90.8% (n=363) of pregnant women. The most common pigmentary change was secondary areola seen in 83% (n=332) women, followed by linea nigra seen in 37.5% (n=150) pregnant women. Vascular changes were seen in 13% (n=52), non- pitting pedal edema being the most common 10.25% (n=41). Connective tissue changes were seen in 62.25% (n=249) of pregnant women, striae gravidarum being the most common (n=242). The most common specific dermatoses of pregnancy was atopic eruption of pregnancy seen in 4.25% (n=17), followed by intrahepatic cholestasis of pregnancy (n= 14). 3 cases (0.75%) of Polymorphic eruption of pregnancy were seen. 1 case of Pemphigoid gestationis was seen in the third trimester. Approximately 17% of pregnant women were positive for infections among which fungal infection was the most common infection affecting pregnant women, seen in 11.2% (n=45) participants. Conclusions: The dermatoses of pregnancy are common and have a range of dermatological manifestations apart from their specific pattern; in order to manage and treat them appropriately, proper attention needs to be given. </p
... All of these conditions are associated with alteration in hormones, vascular, metabolism, and immunologic conditions during pregnancy. 1 One of the prominent physiological changes during pregnancy is the increase of androgens, which induce progression or worsening of acne vulgaris and increasing of hair growth in several body parts. 2 A descriptive study by Urasaki revealed that 91.1 percent of pregnant women developed skin lesions associated with pregnancy and about 67.2 percent of the skin changes has been a ecting their con dence and health. Skin pigmentation is the most common problem during pregnancy, followed by vascular changes, stretch mark, and acne vulgaris. ...
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Objective: We sought to know the efficacy and safety profile of topical products for use during pregnancy. Methods: We used PubMed, Embase, and Cochrane Library to review literature on topical products and pregnancy. Results: A majority of pregnant women develop skin changes, including physiological or hormonal changes, worsening of preexisting skin conditions, or the appearance of new dermatoses during pregnancy. Most pregnant women are concerned about the availability of treatments options with good safety profiles, especially for skin and hair treatments, to maintain their appearance and health. Although most of the treatments are recommended to be used after delivery, there are some alternatives to prevent and treat skin lesions during pregnancy. Conclusion: The most current and comprehensive information about the efficacy and safety profile of topical products in pregnancy are necessary.
... It usually occurs in a localized area and may be due to the regional differences in the density of melanocytes within the epidermal layer of the skin. However, generalized hyperpigmentation can occasionally occur [19,20]. A dark line that forms from the mid suprapubic area to the umbilicus called linea nigra is a common finding in pregnant women as well [4]. ...
Article
Pregnant women are susceptible to various physiological and pathological skin and body habitus changes during pregnancy due to the alterations that occur in a multi-organ-system fashion. Pregnancy can be the onset of different dermatological diseases and can exacerbate pre-existing cutaneous conditions. Moreover, management of dermatologic diseases during pregnancy might be challenging as it requires special attention to both mother and fetus. We aim to assess the most common cutaneous changes and conditions that occur during pregnancy by reviewing the previous studies conducted on this subject. The medical literature was explored through PubMed and Google scholar databases starting from 2015 to 2021. The included searching terms were a combination of "Cutaneous changes and pregnancy," Dermal conditions and pregnancy," Pregnancy-associated dermal conditions," and "Dermatological changes and pregnant women." The inclusion criteria included original articles conducted on pregnant women and full text- articles. A total of 134 articles were obtained, 11 articles were eligible for the inclusion criteria. The 11 studies included a total number of 14,813 pregnant women and covered four countries. The most common cutaneous conditions experienced by pregnant women were primarily physiological skin changes, pregnancy-specific dermatopathologies, and exacerbations of other common skin diseases. All in all, this systematic review concluded that pregnant women are more vulnerable to various dermatological conditions during pregnancy. These changes were more commonly physiological such as hyperpigmentations. However, pathological pregnancy-specific skin conditions and exacerbations of pre-existing dermatoses like atopic eruptions were also reported.
... It has been reported that during pregnancy around 90% of women will undergo skin changes, including mole changes (16). The association between pregnancy and melanoma has been a hot topic for many years with reports supporting the idea that pregnancy increases the risk of melanoma (17). ...
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Changes in melanocytic naevi and development of new naevi have been reported in pregnant women. The association between pregnancy and melanoma is a controversial topic. We conducted this review to identify the dermatoscopic changes that occur in naevi during pregnancy that could facilitate in distinguishing benign from suspicious lesions. Medline, Scopus, and Embase datasets were reviewed for clinical studies on dermatoscopic characteristics of melanoma and naevus in pregnancy. Six cohort studies with a total of 258 patients with 1,167 skin lesions that were examined fulfilled the conditions to be included in the review. None of the patients developed melanoma. Development of new naevi, when reported, was observed in less than half of the participants. The most frequent observed dermatoscopic change among the studies was the increase in the number of dots. Development of new vessels, hypo- and hyperpigmentations and changes in the pigment network were common described changes. The included studies were heterogeneous not allowing head-to-head comparisons between them. Robust and larger studies of dermatoscopic evaluation of naevi in pregnant women are needed to determine high-risk dermatoscopic characteristics.
... [3], из 600 беременных у 4,8 и 1,2%, R. Kumari и соавт. [14] -из 607 женщин у 0,8 и 1,8%, S.P. Rathore и соавт. [4] -из 2000 женщин у 1,6 и 1%. ...
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The appearance of skin changes during pregnancy is inevitable and physiologically determined. This period is characterized by hormonal, immunological and metabolic changes and associated physiological changes in the skin. These include pigmentation (linea nigra, melasma, pseudoacanthosis, growth and appearance of pigmented nevi), changes in connective tissue (striae distensae, skin tags), blood vessels (stellate hemangiomas, erythema of the palms, vasodilatation, edema, cutis marmorata) and skin appendages (increased sebaceous and eccrine glands activity, reduced hair loss and increased hair density, onychodystrophy). It is important to inform women about possible changes, to recognize them in time to reduce the impact of their appearance on the health and course of pregnancy, as well as to avoid unnecessary tests and interventions.
... 4 Infections were the commonest finding in our study(34%);vulvar candidiasis is quite common in pregnancy. 5 It was reported in 8%.Genital warts are the commonest sexually transmitted disease, they tend to increase in size and number during pregnancy. 3 They were the diagnosis in 5%.Chicken pox is a common viral infection, primary infection in the first trimesters of pregnancy may cause intrauterine death or congenital varicella syndrome. ...
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Abbreviations: AEP, atopic eruption of pregnancy, PEP polymorphic eruption of pregnancy; PG, pemphigoid gestationis; ICP, intrahepatic cholestasis of pregnancy Introduction Many skin changes occur during pregnancy as a result of the altered endocrine, metabolic and immunological state. These can be grouped into physiological cutaneous changes, coincidental or preexisting diseases modified by pregnancy and specific dermatoses of pregnancy. The pregnancy specific dermatoses occur exclusively during pregnancy. They have been classified as atopic eruption of pregnancy (AEP), polymorphic eruption of pregnancy (PEP), pemphigoid gestationis (PG) and intrahepatic cholestasis of pregnancy (ICP). They can impact the health of the pregnant woman and the fetus. 1,2 Objectives Our objective was to determine the spectrum of skin disease associated with pregnancy and to identify the various types of pregnancy specific dermatoses and their fetal risk. Materials and methods A prospective study was performed at dermatology outpatient department of Jumhoria hospital and Ibn Sina polyclinic, Benghazi-Libya over a period of 2 years. A total of 200 pregnant women presented with dermatological complaint were included. History, skin examination, and relevant investigations were performed. The Patients with pregnancy specific dermatoses were followed up till delivery and the pregnancy outcome was recorded. The results were analyzed using SPSS. Results Mean age was 32 years, 62% was multigravidae and 54% of pregnancy dermatoses occurred during third trimester. The highest number of cases presented with coincidental or preexisting diseases (71%); infections were the commonest (34%); vulvar candidiasis was reported in 8%, scabies (6%), viral wart (5%), Chicken pox (2%) and measles (1%). Inflammatory skin diseases included eczema (13%), acne vulgaris (4%) plaque psoriasis (3%)and pustular psoriasis (2%). Hyperpigmentation and striea gravidarum represented the main physiological changes (17%). Specific pregnancy dermatoses were present in 12%, these were ICP(4%), AEP(3%), PG(3%) and PEP J Dermat Cosmetol. 2019;3(6):152-155. 152 Abstract Introduction: Cutaneous findings in pregnancy can be physiologic, coincidental, alterations in pre-existing skin diseases or pregnancy specific. The Pregnancy dermatoses can impact the health of the pregnant woman and the fetus
Article
Introduction: Pregnancy is characterized by altered endocrine, metabolic, and immunologic milieus resulting in multiple cutaneous changes, both physiologic and pathologic. This research was undertaken to study physiological changes of pregnancy and prevalence of various pregnancy specific and non-specific dermatoses. Methodology: A retrospective study was conducted at the dermatology out-patient department of a tertiary care center in western India and data of 308 pregnant patients presenting with dermatoses, in the age-group of 19-35 years was analyzed. Detailed history, clinical examination and necessary investigations were reviewed. Results: Among 308 patients, 302(98.05%) presented with physiological skin changes of pregnancy, 118(38.31%) had pregnancy specific and 185(60.06%) had pregnancy non-specific dermatoses. The most common physiological change was pigmentary changes (n=294). Atopic eruption of pregnancy (n=79) was the most common pregnancy specific dermatoses followed by polymorphic eruption of pregnancy (n=38). In non-specific dermatoses, infectious diseases were more common (fungal, n=128; viral, n=25). Conclusion: Pregnancy non-specific dermatoses were seen more commonly than pregnancy specific dermatoses. Lower socioeconomic strata and overcrowding may be the reasons behind large number of infectious dermatoses that we saw in our study.
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Pregnancy is frequently associated with major skin changes. Some of these changes are attributed to pregnancy-specific dermatoses, which often are overlooked and misdiagnosed by physicians. We discuss four major pregnancy-specific dermatoses: pemphigoid gestationis; pruritic urticarial papules and plaques of pregnancy; prurigo of pregnancy; and pruritic folliculitis of pregnancy. Accurate diagnosis and management is crucial, not only to alleviate symptoms, but also to estimate correctly the risk for the fetus.
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Screening for cutaneous disorders was undertaken in 1,175 pregnant women attending ante-natal clinic. Skin disease or STD being encountered in 114 (9.7%). Pruritus was present in 7.1 percent and was mostly due to candidiadis. The physiological skin changes were frequently observed. Candidiasis was by far the commonest infection with a 2.9 percent incidence. Syphilis was the commonest STD followed by Donovanosis and condyloma acuminata. Specific pregnancy dermatoses were seen in 1.5 percent and included prurigo gestationis, pruritic urticarial papules and plaques (PUPPP) and pruritus gravidarum.
Striae are always initiated by stretch whether the stretch is excessive or minimal: spontaneous striae do not occur. Cross-linkage of collagen appears to be more important than amount of collagen in permitting striae in response to stretch. An increase in cross linkage as in age increases the resistance to stretch deformation, but this rigidity leads ultimately to tearing of the skin and not striae. At the other extreme, the absence of crosslinkage leads to "elasticity" and excessive stretching with eventual rupture of the skin if the stretch goes beyond the elastic limit, but again, no striae. Striae appear to occur therefore only in skin in which the rigid cross-linked collagen and "elastic" unlinked collagen thus permitting a limited degree of stretch and a limited intradermal rupture, i.e. striae. (Although rigidity and elasticity are presented here in terms of collagen cross-linkage it seems probable that changes in interfibrillary materials such as glycosaminoglycans will prove important in this respect). This balance of stretch and limited tear is a continuous process and is an adaptation to the needs of growth in adolescence and change in body mass in early adult life and there are many many subclinical "striae" for each gross tear which is recognised clinically. An important factor likewise appears to be rate of stretch since if it is very slow, striae are less likely; there is "give" and new collagen formation. Although this working hypothesis is consonant with the facts only further work will show whether this smooth consonance is that of the fable or the weathered rock of fact.
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An examination of 380 patients was accomplished in order to determine the frequency of occurrence of pigmentary demarcation lines in an unselected population. Both white and black patients were included in the study, and there was an equal sex distribution. Separation of data by age groups enabled us to determine that the age of onset is in early childhood in the majority of cases. Seventy-nine percent of black female adults have at least one type of pigmentary demarcation line, with types A and B being present in over 50% of the cases. Seventy-five percent of black male patients had at least one pigmentary demarcation line, with type C being most prevalent. Fifteen percent of white female patients had one pigmentary demarcation line. Finally, it was determined that seven of fifty black women (14%) had the new appearance of type B lines with pregnancy.
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Pregnancy is a period of profound endocrine and metabolic changes which are tolerated by the body for a relatively short time. During gestation both physiologic and pathologic changes can occur in the skin, nails, and hair shafts which should be recognized and appropriately managed by the dermatologist. These changes can conveniently be placed into five broad categories: (1) physiologic changes in skin and appendages caused principally by the hormonal milieu, (2) cutaneous tumors affected by pregnancy, (3) diseases specifically associated with pregnancy, (4) genital infections of perinatal importance, and (5) other dermatologic diseases influenced by pregnancy. A discussion of each of these topics reveals the vast spectrum of dermatologic disease seen in pregnancy and underscores the important role of the dermatologist in the care of pregnant patients.
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There is little insight into the pathogeneses of most of the specific dermatoses of pregnancy, and therefore they have remained poorly classified. The terminology has become increasingly confusing with several names in use for similar clinical conditions. In an attempt to rationalise the nomenclature we have critically reviewed the clinical descriptions of the dermatoses specifically related to pregnancy and we have proposed a simplified clinical classification into three broad categories: (1) pemphigoid gestationis, (2) polymorphic eruption of pregnancy and (3) pregnancy prurigo.
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We made a prospective study of 60 pregnant women from February 1992 to July 1992. Women with pathologic pregnancies were excluded. Fifty-one women had pigmentary changes; the most frequent was linea nigra in 45. Melasma was observed in 3 women only, and the other local melanosis were rare. Vascular changes appeared in 50 women and vascular spiders in 32. Only one vascular spider was seen on a leg; all the others were on the upper part of the body. Eighteen women had a palmar erythema. New striae distensae appeared in 37 women, the more often on the abdomen. Among the other non classified skin changes, acne appeared in 14 women, oedemas of the legs in 22, oedemas of the eyelids in 3 and molluscum fibrosum gravidarum in 4. We emphasize that skin changes are a frequent and polymorphous feature in pregnancy.