Integumentary System Skin

Many physiologic changes in the skin can occur during gestation. Some are believed to result from changes in the hormonal milieu of pregnancy (see Table 4-2).

TABLE 4-2. Pruritic Dermatologie Disorders Unique to Pregnancy

Disease

Onset Pruritis Lesions

Distribution Incidence

Increased Incidence Fetal

Morbidity/ Mortality

Intervention

Pruritic urticarial

T2-T3

Severe

Erythematous

Abdomen,

Common

No

Topical

papules and

urticarial

thighs,

(0.25-1%)

steroids,

plaques of

papules

buttocks,

antipruritic

pregnancy

and

occasionally

drugs

(PUPPP)

plaques

arms and

(hydroxy

legs

zine,

phenhy-

dramine)

Papular eruptions

T2-T3

Severe

Excoriated

No area of

Uncommon

Unlikely

Systemic/

(prurigo

papules

predilection

(1:300-

topical

gestationis and

1:2,400)

cortico-

papular

steroids, an-

dermatitis)

tipruritics

Pruritis

T3

Severe

Excoriations

Generalized

Common

Yes

Antipruritics,

gravidarum

common

(1-2%)

cholestyra-

mine

Impetigo

T3

Minimal

Pustules

Genitalia,

Rare

Yes (maternal

Systemic

herpetiformis

medial

sepsis

cortico-

thighs,

common)

steroids and

umbilicus,

antibiotics

breasts,

for sec-

axillae

ondary

infection

Herpes gestationis

T2-

Severe

Erythematous

Abdomen,

Rare

Yes

Mild—topical

post-

papules,

extremities,

(1:10,000)

steroids,

partum

vesicles,

generalized

antihista-

bullae

mines

More severe—

systemic corticosteroids w

Melanocyte-Stimulating Hormone Effects

Melanocyte-stimulating hormone increases can result in the following:

■ Linea nigra: Black line/discoloration of the abdomen that runs from above the umbilicus to the pubis; may be seen during the latter part of gestation

■ Darkening of nipple and areola

■ Facial cholasma/melasma: A light- or dark-brown hyperpigmentation in exposed areas such as the face. More common in persons with brown or black skin color, who live in sunny areas, and who are taking OCs.

■ A suntan acquired in pregnancy lasts longer than usual.

Frank goiter may develop due to increased blood flow and hyperplasia of follicular tissue.

Thyroid-stimulating hormone, iodide, thyroid-releasing hormone, and T4 cross the placenta. TSH does not.

Parathyroid hormone and calcitonin do not cross the placenta.

Estrogen Effects

■ Spider nevi are common (branched growths of dilated capillaries on the skin).

■ Palmar erythema

Corticosteroid Effects

Striae on the abdomen, breasts, etc., develop in response to increased circulating corticosteroids.

Fingernails

Grow more rapidly during pregnancy

Hair

The rate at which hair is shed is reduced.

The excess retained hair is often lost in the puerperium, secondary to maternal emotional stress.

NORMAL ANATOMICAL ADAPTATIONS IN PREGNANCY

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