• See Also
  1. Pruritus in Pregnancy
  2. Pruritus
  3. Skin Conditions of Pregnancy
  • Epidemiology
  1. Rare (1 in 60,000 pregnancies)
  2. Primarily in Multiparous patients in second or third trimester of pregnancy
  • Pathophysiology
  1. Associated with HLA-DR3, and HLA-DR4
  2. Autoimmune skin disorder similar to Bullous Pemphigoid
    1. Reaction to hemidesmosomal Proteins within the Dermis and Epidermis
  • Associated Conditions
  1. Grave's Disease
  2. Choriocarcinoma or Molar Pregnancy (rare)
  • Symptoms
  1. Intense, severe Pruritus
  • Signs
  1. Onset in second or third trimester of pregnancy
  2. Polymorphic lesions
    1. Vesicles and bullae
  3. Distribution
    1. Starts on Abdomen
      1. Does not spare the umbilical region (unlike Polymorphic Eruption of Pregnancy)
    2. Spreads to thighs, palms and soles
  • Differential Diagnosis
  1. See Pruritus in Pregnancy
  2. See Pruritus Causes
  3. Pruritic Urticarial Papules and Plaques of Pregnancy (Polymorphic Eruption of Pregnancy)
  • Management
  1. Increased antepartum observation
  2. Oral Antihistamines
  3. Topical Corticosteroids
  4. Systemic Corticosteroids in severe cases
  • Course
  1. Onset in second-half of pregnancy
  2. Improves in late pregnancy
  3. May be exacerbated in early Postpartum Period
  4. May recur in future pregnancies (or with hormonal therapy such as Oral Contraceptives)
  • Complications
  1. Preterm delivery
  2. Small for Gestational Age infant
  3. Newborns dermatitis (10% of cases)
    1. Vesicles and bullae may be transiently seen in newborns due to passive Antibody transfer
  • References
  1. Erlandson (2023) Am Fam Physician 107(2): 152-8 [PubMed]