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Chapter 108. Skin Changes and Diseases in Pregnancy

Julie K. Karen; Miriam Keltz Pomeranz

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    AMA Citation
    Karen JK, Pomeranz M. Karen J.K., Pomeranz M Karen, Julie K., and Miriam Keltz Pomeranz.Chapter 108. Skin Changes and Diseases in Pregnancy. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K. Goldsmith L.A., Katz S.I., Gilchrest B.A., Paller A.S., Leffell D.J., Wolff K Eds. Lowell A. Goldsmith, et al.eds. Fitzpatrick's Dermatology in General Medicine, 8e New York, NY: McGraw-Hill; 2012. http://accessmedicine.mhmedical.com/content.aspx?bookid=392&sectionid=41138822. Accessed September 21, 2019.
    MLA Citation
    Karen JK, Pomeranz M. Karen J.K., Pomeranz M Karen, Julie K., and Miriam Keltz Pomeranz.. "Chapter 108. Skin Changes and Diseases in Pregnancy." Fitzpatrick's Dermatology in General Medicine, 8e Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K. Goldsmith L.A., Katz S.I., Gilchrest B.A., Paller A.S., Leffell D.J., Wolff K Eds. Lowell A. Goldsmith, et al. New York, NY: McGraw-Hill, 2012, http://accessmedicine.mhmedical.com/content.aspx?bookid=392&sectionid=41138822.

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Cutaneous Changes Commonly Associated with Pregnancy at a Glance
  • Cutaneous changes result from the altered endocrine, metabolic, and immunologic milieus that characterize pregnancy.
  • Pigmentary disturbances, including hyperpigmentation, darkening of the linea alba, and melasma are the changes most commonly observed.
  • Significant change in nevi size is not a feature of most pregnancies.
  • Structural changes known to occur during pregnancy include, most commonly, striae distensae.
  • Pruritus is a common complaint during pregnancy and may be related to flare of a preexisting dermatosis or onset of a specific dermatosis of pregnancy.

Pregnancy is characterized by altered endocrine, metabolic, and immunologic milieus. These dramatic alterations result in multiple cutaneous changes, both physiologic and pathologic. A comprehensive list of physiologic alterations within the skin and appendages is provided in Table 108-1.1–3

Table 108-1 Physiologic Skin Changes during Pregnancy
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Table 108-1 Physiologic Skin Changes during Pregnancy

Pigmentary

  • Diffuse hyperpigmentation
  • Selective hyperpigmentation (genitalia, axillae, recent scars)
  • Secondary areolae
  • Linea nigra
  • Melasma (chloasma, mask of pregnancy)
  • Darkening of ephelides and melanocytic nevia

Hair

  • Hirsutism
  • Thickening of scalp hair
  • Postpartum telogen effluvium
  • Postpartum androgenetic alopecia

Nail

  • Subungual hyperkeratosis
  • Distal onycholysis
  • Transverse grooving
  • Brittleness
  • Accelerated growth

Glandular

  • Increased eccrine function (except palms) (miliaria, dyshidrotic eczema, hyperhidrosis)
  • Elevated thyroid activity with resultant relative iodine deficiency
  • Increased sebaceous function (growth in Montgomery's tubercles) (see eFig. 108-0.1)
  • Decreased apocrine function

Structural Changes

  • Striae distensae (striae gravidarum)
  • Molluscum fibrosum gravidarum (acrochordons)

Vascular

  • Spider angiomas (spider nevi, nevi aranei) (Fig. 108-1)
  • Palmar erythema (see eFig. 108-0.2)
  • Nonpitting edema (hands, ankles, feet, face)
  • Varicosities
  • Cutis marmorata
  • Vasomotor instability
  • Dermographism/pruritus
  • Purpura
  • Gingival hyperemia or hyperplasia
  • Pyogenic granuloma (granuloma gravidarum, pregnancy epulis)
  • Hemorrhoids
  • Hemangiomas, hemangioendotheliomas, glomangiomas
  • Unilateral nevoid telangiectasia (unilateral dermatomal superficial telangiectasia)

Mucosa

  • Gingivitis (marginal gingivitis, papillomatous hypertrophy of the gums)
  • Jacquemier–Chadwick sign (bluish discoloration of vagina and cervix)
  • Goodell's sign (cervical softening)

aAlthough some degree of darkening of nevi during pregnancy may be physiologic, any pigmented lesion noted to change should be evaluated in a pregnant woman, as in nonpregnant women.

Data from Elling SV, Powell FC: Physiological changes in the skin during pregnancy. Clin Dermatol 15:35, 1997; Kroumpouzos G, Cohen LM: Dermatoses of pregnancy. J Am Acad Dermatol 45:1, 2001; and Muzaffar F, Hussain I, Haroon TS: Physiologic skin changes during pregnancy: A study of 140 cases. Int J Dermatol 77:429, 1998.

Pigmentary disturbances are the most common of these physiologic changes (see Table 108-1). Hyperpigmentation of the areola, axillae, and genitalia is well documented in pregnancy. Linea nigra refers to the typically reversible darkening of the linea alba, a hypopigmented linear patch extending from the pubis symphysis to the xiphoid process of the sternum (Fig. 108-2). Melasma or chloasma is a related finding comprising irregular, blotchy, facial hyperpigmentation that occurs in up to 70% of pregnant women (see ...

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