Pregnancy can be associated with skin conditions that require medical evaluation because of possible health risks to the mother or her baby. The first manifestation may be itching, which affects up to 20 percent of pregnant women. Itching can be mild but in some instances is severe enough to affect sleep and quality of life. Most often, itching is caused by flare-ups of pre-existing skin conditions like eczema or atopic dermatitis. In such cases, the response to topical corticosteroids and good skin care is usually excellent, and there are no significant effects on fetal or maternal health.
One of the most common rashes specific to pregnancy is called polymorphic eruption of pregnancy (PEP), also known as pruritic urticarial papules and plaques of pregnancy (PUPPP). PEP is linked to rapid weight gain and multiple pregnancies. It usually begins with itchy, hive-like lesions on the abdomen, especially within stretch marks, and may spread to involve the buttocks or thighs. It generally appears during late pregnancy and resolves within four to six weeks after delivery. A diagnosis of PEP is based on the classic appearance. PEP is not associated with increased maternal or fetal risks, and it usually does not recur during subsequent pregnancies.
A more serious condition is pemphigoid gestationis (PG), a rare autoimmune disorder that usually occurs during late pregnancy with an abrupt onset of itchy blisters. These are typically on the abdomen in the umbilical area and can spread to the whole body. An office-based procedure called a skin biopsy, in which a small piece of skin is removed and sent in a special medium to detect immunofluorescence, can clinch the diagnosis. Severe cases usually require oral corticosteroid treatment. PG is associated with an increased risk of prematurity, and the newborn may be small for its age. After delivery, the rash usually resolves within weeks to a few months. Skin manifestations may appear in the infant due to transfer of antibodies across the placenta. It is possible for PG to recur in the mother during subsequent pregnancies.
There are numerous other causes of itching and skin eruptions during pregnancy. The timing of onset, appearance, and distribution of the rash are important diagnostic signs. The dermatologist plays a key role in diagnosis and prompt treatment, which are crucial to protect the mother and her baby.
Post authored by Rina A. Anvekar, MD, a board certified dermatologist, clinical researcher, and clinical educator who practices at both The Mount Sinai Hospital and Mount Sinai Queens. Her clinical interests include acne, eczema, psoriasis, total body skin checks, and skin cancer. Her goal is to enable patients to maintain healthy skin by providing preventative counseling and cutting edge treatment options. She is committed to compassionate, community-oriented patient care and has a passion for resident education.
