Gupta AS
Skin diseases in non pregnant women are usually co incidental and not
specific to pathology of the reproductive system. A gynecologist is
not required to manage dermatological manifestations in women. An
obstetrician does frequently encounter various dermatological
conditions in their pregnant patients. The pregnant woman consults
her obstetrician regarding all dermatological manifestations in
pregnancy rather that visiting a dermatologist primarily. The
obstetrician should therefore be aware about the various skin
manifestations that may manifest in the gravid woman. These
dermatological conditions may be either pre-existing, hormone induced
or pregnancy specific.
Hormone induced changes that are commonly required to be dealt by the
obstetricians include striae gravidarum, chloasma or melasma, skin
pigmentation. The hyper-pigmentation tends to occur on the breast,
vulva, linea alba, face, etc. These are usually physiological effects
of pregnancy and they resolve or reduce in the post postpartum phase
but may recur in future pregnancies. These are very distressing to
the pregnant patient. Vascular changes under the effect of estrogen
also tends to occur in some women like spider nevi, telangiectasias,
palmar erythema, hemorrhoids, and varicosities.
Pre existing dermatological manifestations can include infections
like candidiasis, tinea; eczema's, psoriasis, atopic dermatitis, etc.
Conditions like atopic dermatitis or fungal infections worsen in
pregnancy whereas diseases like psoriasis improve in pregnancy.
Sometimes a condition may remain unaltered by pregnancy.
Pregnancy specific skin conditions are also known as dermatoses of
pregnancy. These are seen only in pregnancy and are a heterogeneous,
poorly defined, itchy, inflammatory cutaneous eruptions. These
usually are seen in the antenatal period and usually settle down in
the puerperium. These are intrahepatic cholestasis of pregnancy,
pemphigoid gestationis, polymorphic eruptions of pregnancy and 3
conditions clubbed under atopic eruption of pregnancy. These 3
conditions included in atopic eruption of pregnancy are eczema in
pregnancy, prurigo of pregnancy and pruritic folliculitis of
pregnancy. The woman is distressed with persistent and repeated
itching. Intrahepatic cholestasis of pregnancy and pemphigoid
gestationis can adversely affect the fetus. In these pregnancies,
fetal monitoring is needed to reduce the risk of fetal distress,
morbidity and mortality.
When an obstetrician encounters a woman with skin lesions, a
consultation with the dermatologist should always be sought in order
to correctly establish a diagnosis and plan the treatment. Many of
these women will require steroid based cutaneous preparations and
some of them may even need systemic anti histaminic and steroid
therapy. Patients with intrahepatic cholestasis of pregnancy will
require treatment with bile acid binding substance like
ursodeoxycholic acid. These women should not have a prolonged
pregnancy and induction of labor may also be considered besides
closer fetal surveillance.
At times an obstetrician also is required to be aware about the skin
manifestations seen in the newborn. Most of the time these are
insignificant occurrences and settle down, however, some of the skin
conditions may be a pointer towards more serious inheritable
conditions like epidermolysis bullosa.
An evaluation of the patient by a dermatologist is the best option
and the patient should always be advised to consult a dermatologist.
We present one case in this issue where the gynecologist was called
upon to manage a case of uterine fibroids which was actually a part
of the Reed’s syndrome or the MCUL syndrome. In our previous issues
the readers have read cases related to dermatological manifestations
in pregnancy and in future also we will publish some more interesting
cases associated with skin lesions which I am sure will be
appreciated by our readers.With this I present the May issue to our
esteemed readers.