II. Signs: General Skin, Hair and Nail Changes
-
Hair Changes
- Hirsutism
- Telogen Effluvium
- Onset in the Postpartum Period and resolves within 12 to 18 months
- Androgen-Related hair changes
- Male pattern baldness and Hypertrichosis may occur during or after pregnancy but is uncommon
- Nail changes (e.g. Onycholysis, brittle nails, grooves)
- Nails become more brittle and grow more quickly in pregnancy (resolves after delivery)
- Onychommycosis is more common in pregnancy
- Vascular changes
- Hyperestrogenic state results in venous dilation and congestion, and small vessel proliferation
- Telangiectasias or Spider Angiomas (67% of pregnancies)
- Palmar erythema (67% of pregnancies, esp. lighter skin)
- Varicose Veins (40% of pregnancies)
- Chadwick Sign
- Darkened or erythematous vulva and vagina
- Goodell Sign
- Purple or blue discoloration of the Cervix
- Results from pelvic vessel congestion
- Gingival Hyperplasia
- Results from increased Gingival edema and hyperemia
- Optimize Dental Hygiene to prevent Gingivitis
- Other common skin changes in pregnancy
III. Causes: Pregnancy-Specific Pruritic Conditions
- See Pruritus in Pregnancy
- Atopic Eruption of Pregnancy is a collection of immunologic-induced Pruritic Conditions
- Common Pruritic Conditions in Pregnancy
- Uncommon Pruritic Conditions in Pregnancy
IV. Causes: Conditions Exacerbated by Pregnancy
-
Acne Vulgaris (up to ~40% of pregnancies)
- Associated with increased androgen levels in second and third trimesters
- Topical Benzoyl Peroxide, Azelaic Acid, Erythromycin Topical 2% (Erygel), Clindamycin Topical 1% (Cleocin-T)
- In severe cases, may consider oral Erythromycin, oral Prednisone <20 mg/day for <1 month or pulsed Light Therapy
- Condylomata acuminata (Genital Warts)
- Start with Cryotherapy, and consider laser therapy if persistent
- Consider Imiquimod or surgical excision for extensive or refractory cases
- Avoid Podophyllotoxin-based agents in pregnancy
- Genital Warts do not contraindicate Vaginal Delivery unless obstructing pelvic outlet or significant bleeding risk
-
Genital Herpes
- See Genital Herpes in Pregnancy
- Genital Herpes recurs during pregnancy in 75% of women with known genital HSV
- High risk of vertical transmission with primary outbreak in third trimester
- Viral suppression (Acyclovir or Valacyclovir) from 36 weeks until delivery
- Cesarean Section if active lesions or prodromal Genital Herpes symptoms at time of delivery
-
Hidradenitis Suppurativa
- May worsen (20%) or improve (24%) with pregnancy
- Worsens for 60% in the Postpartum Period
- Topical Benzoyl Peroxide or Clindamycin Topical 1% (Cleocin-T) and oral Cephalexin or Amoxicillin-clavulanate
- Severe, refractory cases may be treated with intralesional Corticosteroid, laser therapy, surgical excision
-
Pityriasis Rosea (RR 3 in pregnancy)
- Average duration in pregnancy 45 days, treating with supportive care, and resolves spontaneously
- Miscarriage rates may be >60% when it occurs <15 weeks gestation (esp. high titers, systemic symptoms, >50% BSA)
-
Psoriasis
- Most Psoriasis improves during pregnancy and worsens postpartum (but variable across pregnancies)
- Start with topical Skin Lubricants and low to moderate potency Topical Corticosteroids, followed by UVB Phototherapy
- In severe cases after first trimester, TNF Inhibitors, Cyclosporine and Systemic Corticosteroids may be considered
- Impetigo Herpetiformis (Pustular Psoriasis of Pregnancy)
-
Skin Tags
- May develop or hypertrophy in pregnancy
- Typically regress after pregnancy