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妊娠皮膚病簡介

妊娠皮膚病簡介. 生理的變化. Enlarged of the intermediate lobe of the pituitary gland , the melanocyte-stimulating hormone (MSH) became remarkably elevated by 8 weeks gestation. 常見的變化 -Hyperpigmentation. 90% : skin darkening ; MSH and estrogen

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妊娠皮膚病簡介

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  1. 妊娠皮膚病簡介

  2. 生理的變化 • Enlarged of the intermediate lobe of the pituitary gland , the melanocyte-stimulating hormone (MSH) became remarkably elevated by 8 weeks gestation

  3. 常見的變化-Hyperpigmentation • 90% : skin darkening ; MSH and estrogen • Beginning early in pregnancy and more pronounced in naturally hyperpigmented areas such as areolare , perineum and umbilicus and axillae and inner thigns, Linea nigra • Face: cholasma or melasma ; 50% , sunscreens ; Regress postpartum , dermal melanosis persist up to 10 years in 1/3 pts • 2-5% hydroxquinone , 0.1% tretinoin gel or cream or 20% azelaic acid cream

  4. cholasma or melasma 黑斑 or 肝斑 Linea nigra

  5. 常見的變化-Navi • Pigmented cutaneous tumors commonly enlarge and darken during pregnancy , leading to their confusion with malignant melanomas. • 6% changed in diameter over pregnancy • No evidence that they undergo malignant transformations

  6. 常見的變化-Hair Growth • Growing hair phase is increased related to the resting hair phase • Estrogen prolong the growing hair phase and androgens cause enlargement of follicles • Telogen effluvium: abrupt hair loss beginning 1 to 4 months postpartum ; self limited and restored in 6 to 12 months

  7. 常見的變化-Vascular change • Augmented cutaenous blood flow: estrogen and decreased vascular resistance • Spider angiomas : 2/3 white and 1/10 black • Palmar erythema : 2/3 white and 1/3 black • Papillary hemangiomas: 5% • Pregnancy gingivitis (epulis): growth of the gum capillaries • Pyogenic granuloma of pregnancy (granuloma gravidarum) : oral cavity and arise from the gingival papillae

  8. Spider angiomas Palmar erythema

  9. Pyogenic granuloma of pregnancy Pregnancy gingivitis (epulis)

  10. 妊娠紋 • 80～90﹪的孕婦 • 懷孕6～7個月後開始產生，除了肚子之外，大腿、腹股溝甚至胸部都有可能出現粉紅或紫紅色萎縮性斑紋。 • 除了荷爾蒙的影響，體重增加太快也是促成原因之一。 • 雖然在產後會慢慢變白、變細， 但很多人是無法完全恢復的 • 控制體重 • 含果酸的乳液或其他可促進 彈力纖維生成的妊娠霜，來緊緻皮膚， 預防妊娠紋產生。倘若妊娠紋已產生 ，在產後且妊娠紋尚未變白前， 可接受脈衝光治療，有改善的機會。

  11. Dermatoses of pregnancy • 1.6 % of women had significant pruritus at some time during prengancy • Pruritus gravidarum • Prurutuc ureticarial papules and plaques of pregnancy • Herpes gestationis

  12. Pruritus Gravidarum • 0.6% pregnancy with pruritus : mild variant of intrahepatic cholestasis of pregnancy • Scratching and excoriation  skin lesions • Hormone,genetics and enviornmental factors

  13. Pruritic urticarial papules and plaques of pregnancy • PUPPP in US ; Polymorphic eruption of pregnancy (PEP) in UK • 1/200 singleton , 8/200 for twin • Pruritic cutaneous eruption that usually appears late in pregnancy ; abdomen firstly and then buttocks and thighs and extremities. • 40%: urticarial ; 45% erythematous pattern ; 15% combination; face spared and common in nulliparas and seldom recurs in subsequent pregnancy . • Resemble herpes gestationis but no veiscles or bullae

  14. Prurigo of pregnancy • Papular eruptions of pregnancy • Prurigo gestationis and papular dermatitis • Prurigo gestationis : small pruritic , rapidly excoriated lesions on the forearms and trunk • No vesicles or bullae • Onset at 25 to 30 weeks and may persist for 3 months after delivery • Recurrence is common • Oral antihistamines and topical corticosteriod creams • Perinatal outcome : not affected

  15. Herpes gestationis (1) • Noninfectious disorder • Autoimmue pruritic blistering skin eruption affects multiparous women in late pregnancy and may begin early in pregnancy or within a week or postpartum • Pemphioid gestationis : immunologically similar to bullous pemphgoid • 1/5000 pregnancies • Extremely pruritic widespread eruption with lesions that vary from erythematous and edematous papules to large , tense vesicles and bullae.

  16. Herpes gestationis (2) • Topical corticosterioids and oral antihistamines • Orally pregnisone 0.5 to 1 mg/kg daily , brings relief and inhibits formation of new lesions • The healed sites are not scarred but frequently are hyperpigmented • Refractory cases: immunosuppresives , such as cyclophosphamide , methotrexazte and cyclosporine. • Bullous pemphigoid : plasmapheresis and high dose IG therapy

  17. Herpes gestationis (3) • Reports of association with preterm birth , stillbirths and growth restriction • Increased surveillance is recommended • Lesions similar to those of the mother develop in up to 10% of neonates

  18. Preexisting skin disease • Acne: Isotretinoin , etretinate and tretinoin are strictly contradicted in pregnancy – teratogenic • Pregnancy : topically applied benzoyl peroxide and clindamycin or erythromycin gel • Topical tretinoin is thought to pose no significant teratogenic risk

  19. Preexisting skin disease(2) • Psoriasis improves in up to 50% during pregnancy and 20 % worse • Localized : Topical corticosteroids calciportriene , antrhalin and tacrolimus • Generalized mild disease: UV-B phtotherapy or plus psoralens and oral cyclosporing if unsuccessful • Moderate and severe: plus topical or oral corticosteriods • Coal tar derviatives as well as oral and systemic immunosupressives ( MTX, cyclosporine , tacrolimus) are avoided

  20. Thank you for your attention

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