The Clinical Picture

A dermatosis of pregnancy

Susana Brás, MD, André Oliveira, MD, Pedro Mendes-Bastos, MD and Cristina Amaro, MD
Cleveland Clinic Journal of Medicine June 2017, 84 (6) 440-441; DOI: https://doi.org/10.3949/ccjm.84a.16088

On the eighth day after giving birth to monochorionic twins, a 33-year-old woman presented with pruritic erythematous papules and plaques that started on the striae of the lower abdomen and spread rapidly to the thighs and upper limbs, sparing the umbilical region (Figure 1). Histologic examination of a specimen of the abdominal plaques showed moderate superficial perivascular lymphohistiocytic infiltrate with eosinophils (Figure 2), leading to the diagnosis of polymorphic eruption of pregnancy. Oral cetirizine 10 mg/day and topical methylprednisolone cream brought complete regression of the lesions within 1 month.

FIGURE 1
FIGURE 1

Erythematous papules and plaques on the upper limbs and in the lower abdominal striae, sparing the umbilical region.

FIGURE 2
FIGURE 2

Histologic study of the abdominal plaque showed moderate superficial perivascular lymphohistiocytic infiltrate with eosinophils (arrows). Epidermal cells (arrowheads) appeared normal (hematoxylin and eosin, × 10).

DERMATOSES OF PREGNANCY

Polymorphic eruption of pregnancy—also known as pruritic urticarial papules and plaques of pregnancy1—is a specific dermatosis of pregnancy characterized by pruritic urticarial papules on abdominal striae that usually first appear during the latter portion of the third trimester or immediately postpartum. It is more frequent in primiparous women and does not represent a risk to the mother or fetus.2–4

The lesions tend to coalesce into plaques, spreading to the buttocks and proximal thighs. They then become more polymorphic and vesicular, with widespread nonurticated erythema and targetoid and eczematous lesions. Characteristically, the lesions spare the umbilical region. Their location within striae suggests that stretching of abdominal skin may damage the connective tissue, initiating an immune response with subsequent appearance of the eruption.2,4

The diagnosis is mainly clinical. In some cases, skin biopsy can help to confirm the diagnosis. Histologic features are nonspecific and vary with the stage of disease, showing a superficial to mid-dermal perivascular lymphohistiocytic infiltrate with eosinophils. At earlier stages, biopsy results can show a prominent dermal edema.

In later stages, epidermal changes such as spongiosis, hyperkeratosis, and parakeratosis can occur.2

As an aid to diagnosis, Table 1 lists clinical differences between various dermatoses of pregnancy.

View this table:
TABLE 1

Clinical presentation of dermatoses of pregnancy

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