Pruritus in pregnancy: treatment of dermatoses unique to pregnancy

Abstract

Question: Some of my pregnant patients complain about pruritus. Are there conditions in pregnancy that present with pruritus that might put the mother or fetus at risk?

Answer: Although most cases of pruritus can be attributed to itchy dry skin, there are conditions unique to pregnancy that involve pruritus as a leading symptom. These include pemphigoid gestationis, pruritic urticarial papules and plaques of pregnancy, intrahepatic cholestasis of pregnancy, and atopic eruption of pregnancy. These conditions are associated with severe pruritus and some might be associated with adverse fetal outcomes. Clinical history and physical examination are the most important diagnostic clues when evaluating pruritus in pregnancy.

Figure 1.

Diagnostic approach to pruritus in pregnancy AEP—atopic eruption of pregnancy, C3—complement C3, DEJ—dermoepidermal junction, H and E—hematoxylin-eosin, ICP—intrahepatic cholestasis of pregnancy, IgE—immunoglobulin E, IMF—immunofluorescence microscopy, PEP—polymorphic eruption of pregnancy, PG—pemphigoid gestationis, PUPPP—pruritic urticarial papules and plaques of pregnancy. *PUPPP is also referred to as PEP. Adapted with permission from Ambros-Rudolph et al.