Report
The specific dermatoses of pregnancy revisited and reclassified: Results of a retrospective two-center study on 505 pregnant patients

https://doi.org/10.1016/j.jaad.2005.12.012Get rights and content

Objectives

We sought to evaluate the frequency and clinical characteristics of pruritic dermatoses in pregnancy and to assess a rationalized classification.

Methods

Data of 505 pregnant patients seen at two university-based dermatologic hospitals (1994-2004) were retrospectively studied.

Results

Diagnoses included eczema in pregnancy (49.7%), polymorphic eruption of pregnancy (PEP) (21.6%), pemphigoid gestationis (PG) (4.2%), intrahepatic cholestasis of pregnancy (ICP) (3%), prurigo of pregnancy (0.8%), pruritic folliculitis of pregnancy (0.2%), and miscellaneous dermatoses (20.6%). Eczema in pregnancy, prurigo of pregnancy, and pruritic folliculitis of pregnancy showed considerable overlap and were summarized as atopic eruption of pregnancy (AEP). While PEP, PG, and ICP presented in late pregnancy, AEP started significantly earlier. Primigravidae and multiple gestations were characteristic for PEP, abdominal involvement for PEP and PG, and a history of affected pregnancies for ICP.

Limitations

This was a retrospective study.

Conclusion

We propose classifying the dermatoses of pregnancy as PG, PEP, AEP, and ICP. Stereotypic immunofluorescence and laboratory findings are diagnostic of PG and ICP, whereas distinct clinical characteristics facilitate discrimination between PEP and AEP.

Section snippets

Methods

During a 10-year period, a total of 596 consecutive pregnant patients were seen for various skin diseases in a center in London, United Kingdom (1994-2004, n = 420), and another in Graz, Austria (1999-2004, n = 176). A retrospective review was performed by means of medical record analysis. Data from 505 patients (London, n = 355; Graz, n = 150) who presented with a generalized pruritic skin condition that first developed during their pregnancy were included into this study. Excluded were 95

Results

A total of 505 patients with a median age of 30 years (range: 15-45 years) were included into this study. In all, 104 patients (20.6%) given a diagnosis of miscellaneous skin diseases coinciding with pregnancy were not further analyzed and are detailed in Table II. The other 401 patients were categorized as follows: EP, 251 patients (49.7%); PEP, 109 (21.6%); PG, 21 (4.2%); ICP, 15 (3.0%); PP, 4 (0.8%); and PF, 1 (0.2%).

The most frequent skin disorder in pregnancy seen in our patients was EP.

Discussion

There are limited data on the frequency and clinical characteristics of the various pruritic dermatoses of pregnancy and their terminology has been misleading and confusing. The two current classification schemes are equivocal and include entities of provisional character. The recent observation of a high prevalence of EP, making it a crucial differential diagnostic consideration, is not acknowledged by either of them. In this retrospective two-center study on 505 pregnant patients with a

References (29)

  • S.A. Vaughan-Jones et al.

    Neutrophil folliculitis and serum androgen levels

    Clin Exp Dermatol

    (1999)
  • J.K. Shornick

    Pregnancy dermatoses

  • D. Roger et al.

    Specific pruritic diseases of pregnancy: a prospective study of 3192 pregnant women

    Arch Dermatol

    (1994)
  • S.A. Vaughan-Jones et al.

    A prospective study of 200 women with dermatoses of pregnancy correlating clinical findings with hormonal and immunopathological profiles

    Br J Dermatol

    (1999)
  • Cited by (264)

    • Autoimmune blistering diseases in primary care

      2022, FMC Formacion Medica Continuada en Atencion Primaria
    View all citing articles on Scopus

    Funding sources: None.

    Conflicts of interest: None identified.

    View full text