Dermatoses específicas da gravidez
Focus on:
- Onset timeline in the pregnancy
- Mother and fetal complications
- Risk of recurrence with future pregnancies
Name | Mechanism | Presentation | Onset | Complications | Recurrence |
Polymorphic eruption of pregnancy (PEP) | Stretching of abdominal skin | Begins in striae Periumbilical sparing Primiparous women Multiple gestations | Late 3rd trimester or postpartum (striae) | No maternal or fetal risks | Unlikely to reccur |
Gestational Pemphigoid | Antibodies to BPAG2 or BP180 | Begins around umbilicus | Late pregnancy or postpartum | Newborn: self-limited skin involvement, prematurity, low birth weight (anticorpos tb atacam placenta) Mother: Grave’s disease | Flares can occur with: - subsequent pregnancies - menstruation - oral contraceptive pills |
Intrahepatic cholestasis of pregnancy | elevated bile acids | prurido, no primary lesions, but +/- secondary lesions Steatorrhea Vit K deficiency → maternal hemorrhage | 3rd trimester | Newborn: premature labor, fetal complications Maternal: hemorrhage | Often recurs in subsequent pregnancies (45-70%) and with oral contraceptive pills |
Atopic eruption of pregnancy | Predominance of Th2 immune response during pregnancy | Pruritic papules and eczematous plaques | EARLY during pregnancy | No maternal or fetal risk | Likely to recur |
Abordagem (HIGH YIELD)
Dermatoses prévias influenced by pregnancy
- Se há um shift Th1→Th2 na gravidez faz sentido que a psoríase melhore, mas o eczema atópico, e o lupus e penfigo possam agravar
Dermatite Atópica
- Agravamento (desvio Th2)
Psoríase
Pustular psoriasis of pregnancy | Impetigo herpetiformes- Geralmente melhora (desvio Th2)
Melanoma
- Durante a gravidez → mais mortalidade relacionada com melanoma
- Redução do sistema imunitário (Th1) durante a gravidez
- Linfangiogénese e angiogénese durante a gravidez
Lupus
- Durante a gravidez, uma subida do estrogénio pode provocar um agravamento ou flare do lupus, pelo que poderá justificar-se subir o tratamento antes da gravidez
Keloids
- Often flare up during pregnancy
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