妊娠期皮肤病.ppt

《妊娠期皮肤病.ppt》由会员分享，可在线阅读，更多相关《妊娠期皮肤病.ppt（35页珍藏版）》请在淘文阁 - 分享文档赚钱的网站上搜索。

1、Pregnancy dermatoses2009.08.11Physiologic skin changes in pregnancyDermatoses exacerbated by pregnancyDermatoses only occurring in pregnancySpecific dermatoses of pregnancyPhysiologic skin changes in pregnancy妊娠期皮肤的生理变化Hyperpigmentation 色素沉着Occurs in 90%of pregnant womenIncreased melanocyte-stimulat

2、ing hormoneAccentuation on areolae,genital skin,and linea albaUsually regresses postpartumMelasma 黄褐斑Occurs in 70%of pregnant womenAlso seen with oral contraceptivetherapyCentrofacial,malar,and mandibular patternsExcessive melanin in epidermis or dermal macrophagesWorsens with UVB exposureHirsutism

3、多毛症Face,limbs,and backRegresses within 6 months postpartumSlowed conversion from anagen to telogen hairsNail changes 甲改变 Transverse grooving Brittleness Distal onycholysisIncreased eccrine gland activity 内分泌腺活性增加MiliariaDyshidrotic eczemaHyperhidrosisDecreased apocrine gland activity大汗腺活动性减少Hidraden

4、itis suppurativa alleviatedIncreased sebaceous gland activity 皮脂腺活动性增加Exacerbation of acne vulgarisMontgomerys tubercles enlargeStriae distensae妊娠纹Occur in 90%of pregnant womenPink or purple atrophic longitudinal bandsCaused by increased adrenocortical activityFade postpartum to persistent pale atro

5、phic bandsVascular changes血管变化Spider neviPalmar erythemaNonpitting facial edemaVenous varicosities:LegsVasomotor instabilityDermographismEdema and hyperemia of gingivaeDermatoses exacerbated by pregnancy妊娠期加重的皮肤病Atopic eczema 特应性皮炎May deteriorate or remit during pregnancylimbs and/or trunk and faceM

6、ay present for the first time in pregnancy in predisposed personIrritant hand dermatitis and nipple eczema common postpartumTreatment:topical corticosteroids,emollients,UVBPsoriasis 银屑病Most common type:chronic plaque psoriasisDifferential diagnosis of pustular variant from impetigo herpetiformis may

7、 be difficultTopical treatment:Dithranol,calcipotriol,tar,and corticosteroids are all safe in pregnancySystemic drugs:retinoids,methotrexate,and hydroxyurea are all contraindicated in pregnancy.Cyclosporine should be used with caution during pregnancy and breast-feeding.Acne vulgaris寻常痤疮Urticaria荨麻疹

8、Lichen planus扁平苔藓Infections 感染性皮肤病Viral(herpes simplex,varicella zoster)Bacterial(impetigo,trichomoniasis,leprosy)Fungal(candidal,Pityrosporum folliculitis)AIDSLupus erythematosus(LE)Debate continues：whether lupus flares are more common in pregnancy.Cutaneous flares are the most common,followed by a

9、rthritis.Painful vasculitic lesions on the peripheries are the most common skin lesions.Neonatal LE is seen in babies of mothers with circulating anti-Ro(SSA)antibodies and can lead to congenital heart block.The antiphospholipid syndrome presents with thrombosis,recurrent miscarriage,livedo reticula

10、ris,migraine,stroke,and/or thrombocytopenia.Treatment with systemic corticosteroids and antimalarials should not be stopped in pregnancy,to prevent an acute flare.Systemic sclerosisPolymyositis/DermatomyositisPemphigusCutaneous tumors affected by pregnancyPyogenic granulomaHemangiomaHemangioendothel

11、iomaGlomus tumorDermatofibromaLeiomyomaKeloidNeurofibromaNeviMelanomaDermatoses only occurring in pregnancy仅发生在妊娠期的皮肤病Impetigo herpetiformis疱疹样脓疱病Reminiscent of pustular psoriasis,no prior history of psoriasisAssociated with hypoparathyroidism and hypocalcemiaSystemic upset with malaise,fever,deliri

12、um,diarrhea,vomiting,and tetany secondary to hypocalcemiaErythematous patches with pustular margin in flexural distributionSparing of face,hands,and feetPostinflammatory hyperpigmentation commonHistopathologic features identical to pustular psoriasis with spongiform pustules of Kogoj,large collectio

13、ns of neutrophils within foci of spongiotic epidermisLaboratory findings:Elevated leukocyte count and erythrocyte sedimentation rate,hypocalcemiaTreatment:Prednisolone 30-40 mg dailyPrognosis:Stillbirth and placental insufficiency still frequently seen even when disease is apparently controlled.Remi

14、ssion postpartum but recurrence in successive pregnancies occurs frequently.Intrahepatic cholestasis of pregnancy妊娠期肝脏内胆汁郁积Increased incidence Presents in third trimester with severe intractable pruritus Clinical:Often only excoriations;clinical jaundice rare;mal-absorption of fat can lead to weight

15、 loss and vitamin K deficiency in severe casesUsually nonresponsive to antihistamines and topical emollientsHistopathologic findings:Skin findings nonspecific;liver biopsy specimen will reveal typical changes in severe cases with dilated bile canaliculi,staining of parenchyma with bile pigments and

16、minimal inflammation.These changes are reversible postpartum.Pathophysiology:Associated with HLA subtype B8 and BW16 and positive family history in up to 50%of cases.Physiologic concentrations of estrogens thought to interfere with hepatic bile acid secretionAbnormal serum liver function tests(LFTs)

17、and elevated serum bile acids confirm the diagnosis Treatment:Antipruritic emollients,Ion-exchange resins,UVB,evening primrose oil.Prognosis:Increased rate of fetal distress,stillbirth,and preterm delivery.Specific dermatoses of pregnancy妊娠特异性皮肤病Pruritic urticarial papules and plaques of pregnancy(P

18、UPPP)妊娠多形疹Incidence between 1 in 160 women and 1 in 300Presents in primiparous women in third trimester or postpartumIncreased incidence in multiple pregnancyRare recurrence in subsequent pregnancies Onset with pruritus within striae on abdomen;periumbilical sparing may occurClinically characterized

19、 by various lesions including erythematous plaques,papules,vesicles,purpura,and erythema multiformelike lesionsSubsequent spread to breasts,upper thighs,and arms,sparing faceSerologic and immunofluorescence tests negativeSubtype described in which IgM deposition seen either on direct or indirect imm

20、unofluorescence Histopathologic characteristics:Spongiosis in epidermis with perivascular or upper dermal chronic inflammatory cell infiltratePathophysiology:Unknown,although several theories including the role of sex hormones and abdominal wall distension caused by pregnancyPrurigo of pregnancy妊娠痒疹

21、Described by Besnier in 1904Incidence approximately 1 in 300Similar to nodular prurigo seen in nonpregnant personsLikely to be same eruption that Spangler described as papular dermatitis of pregnancyPruritic papules on extensor aspects of limbs and on abdomenNormal maternal and fetal prognosisHistop

22、athologic features:Chronic inflammatory cell infiltrate in upper dermis with occasional epidermal featuresPathophysiology:Unknown,although thought to be a result of physiologic pruritus in women with an atopic backgroundTreatment:Moderately potent topical corticosteroids,antihistaminesPrognosis:No a

23、dverse effects to mother or infant;resolution postpartumHerpes gestationis 妊娠疱疹Autoimmune bullous disorder,closely related to bullous pemphigoid(BP)Rare with incidence of approximately 1 in 60,000Onset usually in second and third trimester or postpartum periodRecurrence common in subsequent pregnanc

24、y at earlier gestation and with increased severity(apart from skip pregnancies,which occur when a woman with known PG has a subsequent unaffected pregnancy)Pruritic erythematous plaques,which become annular or polycyclic,developing into vesicles or bullaePeriumbilical involvement in 87%of casesTrans

25、placental transfer of antibodies can result in neonatal involvementAssociated with low birth weight and premature birth caused by placental insufficiencyHistopathologic features:Similar to PEP in early phases;subepidermal separation with basal cell necrosis;eosinophilic spongiosisImmunofluorescence

26、diagnostic test:Positive direct immunofluorescence with IgG and complement 3 staining at the basement membrane zone and staining to the roof on indirect immunofluorescence using salt-split skinPathophysiology:HLA-DR3,DR4 subtypes associated;close relationship to BP,sharing same target antigen BP-180

27、 kd(BP-AG2),a component of hemidesmosomes;anti-HLA antibodies found in serum of patients with PGTreatment:Mild cases will respond to potent topical steroids;most cases require systemic corticosteroids with gradual dose reduction as disease remits;postpartum flare often occurs;oral contraceptive ther

28、apy also leads to disease flare;Goserelin(LHRH analogue)(chemical oophorectomy)used in severe cases in postpartum phasePruritic folliculitis of pregnancy妊娠瘙痒性毛囊炎Pruritic erythematous follicular papules and urticarial lesions on limbs and abdomen in most casesOnset in second and third trimester with resolution within 2 to 3 weeks postpartumHistopathologic features:Acute folliculitis with mixed inflammatory cells,upper dermal edema and spongiosis;negative Grams stainPathophysiology:Unknown;maternal androgens not implicated as previously suggestedPrognosis:Maternal and fetal outcome normal