Cutaneous manifestations in pregnancy: Pre-existing skin diseases
A number of chronic dermatological conditions can worsen the pregnancy. These may occur before conceiving or manifest for the first time during pregnancy as a result of hormonal and immunological change. These are the following pre-existing skin diseases: atopic dermatitis, seborrhoeic dermatitis, psoriasis, acuminate condyloma and genital herpes infections.
Atopic dermatitis (atopic eczema) is a chronic inflammatory skin disease accompanied by pruritus. No skin lesions are present, only secondary types, as erythema, desquamation, lichenification, and sometimes papules. Lesions may exude secretions and secondary bacterial infections may be present. Atopic dermatitis can be associated with hay fever and / or asthma. This skin condition may improve during pregnancy. Treatment involves the use of topical steroids. Soap should be limited only in critical areas: on hands, face, axles and the inguinal areas.
Seborrheic dermatitis is characterized by hyperemia and scaling of the scalp, as well as of the para-nasal, sub-metamorphic, post-auricular, sternal, inframamar, axillary, umbilical and inguinal areas. The cause remains uncertain, although there was found that Malassezia fungus is involved in the pathogenic contact with the skin barrier. The treatment includes the use of topical corticosteroids, ketoconazole cream, and selenium sulfide foam. Occlusive agents, such as moisturizing creams and vaseline can cure dermatitis.
Psoriasis is a chronic inflammatory and proliferative disorder of the skin that is characterized by erythematous plaques surrounded by a silver margin. Psoriasis may vary during pregnancy. Some retrospective studies commonly show improvement or no change in this skin condition during pregnancy. The treatment includes topical corticosteroids, calcipotriol and tar. Oral antidiabetics such as methotrexate, hydroxyurea and retinoids are contraindicated during pregnancy.
Human Papillomavirus (HPV) is a virus with over 40 pathological types in humans. Warts can occur in any part of the body and may be referred to as verrucae vulgaris. When located in the genital area, these are usually called condylomata acuminata, which often appear as skin-colored, cauliflower-like exophy masses. The amount of viral DNA is also highly increased during pregnancy. Diagnosis of HPV infection is important, since some strains can be transmitted to the fetus through the maternal infected birth canal, being subsequently associed with juvenile respiratory papillomatosis among infected newborns. Respiratory papillomatosis in children is rare, compared with the incidence of condylomas in women of childbearing age. Thus, the cesarean section in this situation is a controversial issue due to the risks of the surgical intervention itself. Treatment during pregnancy includes topical preparations with salicylic acid trichloroacetic acid, cryotherapy, cauterization or laser ablation. Other topical agents such as podophyllin are contraindicated during pregnancy. No treatment showed a higher success rate than 70%, as the virus remains in the body for the lifetime.
Infection with HSV
Herpes simplex virus (HSV) is a common cause of viral infections worldwide. HSV-1 and HSV-2 cause both primary and recurrent infections, the primary ones being more severe. Clinical infection occurs through vesicles grouped on an erythematous basis that can later erode and form ulcers. The lesions commonly occur around the mouth and are called herpes simplex labialis. Asymptomatic carriers of herpes virus who lack any skin lesions have been identified. Infection with genital herpes (herpes progenitalis) at birth is associated with an increased risk of enonatal infection.
The visceral organs are severely impaired in infected newborns, even in the absence of skin lesions. It is highly important to diagnose and treat herpetic infection during pregnancy. Patients at high risk for HSV infection should be tested weekly for viral cultures, and if there is evidence of active infection or viral carriers, caesarean section is recommended to be performed. Acyclovir is an antiviral preparation of category C during pregnancy, which is used for primary or symptomatic infections. Valaciclovir (Category B in pregnancy) is also used in HSV treatment during pregnancy.
Acest text face parte din ghidul „Dermatological disorders and pregnancy”, destinat studenţilor anglofoni, în curs de apariţie la USMF “Nicolae Testemiţanu” din Republica Moldova.
- Luminița Mihalcean, doctor în ştiinţe medicale, asistent universitar, Catedra Obstetrică și Ginecologie;
- Hristiana Caproș, doctor în ştiinţe medicale, asistent universitar, Catedra Obstetrică și Ginecologie.
- Boris Nedelciuc, doctor în ştiinţe medicale, conferenţiar universitar, Catedra Dermatovenerologie;
- Stelian Hodorogea, doctor în ştiinţe medicale, conferenţiar universitar, Catedra Obstetrică și Ginecologie.
Bibliografia la autori.
Din aceeaşi categorie:
- Cutaneous manifestations in pregnancy: Main dermatoses – http://e-dermatologie.md/cutaneous-manifestations-in-pregnancy-main-dermatoses/
- Cutaneous manifestations in pregnancy: Skin changes – http://e-dermatologie.md/cutaneous-manifestations-in-pregnancy-skin-changes/
- Cutaneous manifestations in pregnancy: Generalities – http://e-dermatologie.md/cutaneous-manifestations-in-pregnancy-generalities/