妊娠期皮肤病.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Pregnancy,dermatoses,2009.08.11,Physiologic skin changes in pregnancy,Dermatoses,exacerbated by pregnancy,Dermatoses,only occurring in pregnancy,Specific,dermatoses,of pregnancy,Physiologic skin changes in pregnancy,妊娠期皮肤的生理变化,Hyperpigmentation,色素沉着,Occurs in 90%of pregnant women,Increased,melanocyte,-stimulating hormone,Accentuation on,areolae,genital skin,and,linea,alba,Usually regresses postpartum,Melasma,黄褐斑,Occurs in 70%of pregnant women,Also seen with oral,contraceptivetherapy,Centrofacial,malar,and,mandibular,patterns,Excessive melanin in epidermis or dermal macrophages,Worsens with UVB exposure,Hirsutism,多毛症,Face,limbs,and back,Regresses within 6 months postpartum,Slowed conversion from,anagen,to,telogen,hairs,Nail changes,甲改变,Transverse grooving,Brittleness,Distal,onycholysis,Increased,eccrine,gland activity,内分泌腺活性增加,Miliaria,Dyshidrotic,eczema,Hyperhidrosis,Decreased,apocrine,gland activity,大汗腺活动性减少,Hidradenitis,suppurativa,alleviated,Increased sebaceous gland activity,皮脂腺活动性增加,Exacerbation of acne,vulgaris,Montgomerys tubercles enlarge,Striae,distensae,妊娠纹,Occur in 90%of pregnant women,Pink or purple atrophic longitudinal bands,Caused by increased,adrenocortical,activity,Fade postpartum to persistent pale atrophic bands,Vascular changes,血管变化,Spider nevi,Palmar,erythema,Nonpitting,facial edema,Venous varicosities:Legs,Vasomotor instability,Dermographism,Edema and hyperemia of,gingivae,Dermatoses,exacerbated by pregnancy,妊娠期加重的皮肤病,Atopic,eczema,特应性皮炎,May deteriorate or remit during pregnancy,limbs and/or trunk and face,May present for the first time in pregnancy in predisposed person,Irritant hand dermatitis and nipple eczema common postpartum,Treatment:topical corticosteroids,emollients,UVB,Psoriasis,银屑病,Most common type:chronic plaque psoriasis,Differential diagnosis of,pustular,variant from impetigo,herpetiformis,may be difficult,Topical treatment:,Dithranol,calcipotriol,tar,and corticosteroids are all safe in pregnancy,Systemic 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,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,),AIDS,Lupus,erythematosus,(LE),Debate continues,：,whether lupus flares are more common in pregnancy.,Cutaneous,flares are the most common,followed by arthritis.,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,reticularis,migraine,stroke,and/or thrombocytopenia.,Treatment with systemic corticosteroids and,antimalarials,should not be stopped in pregnancy,to prevent an acute flare.,Systemic sclerosis,Polymyositis/Dermatomyositis,Pemphigus,Cutaneous,tumors affected by pregnancy,Pyogenic,granuloma,Hemangioma,Hemangioendothelioma,Glomus,tumor,Dermatofibroma,Leiomyoma,Keloid,Neurofibroma,Nevi,Melanoma,Dermatoses,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 psoriasis,Associated with,hypoparathyroidism,and,hypocalcemia,Systemic upset with malaise,fever,delirium,diarrhea,vomiting,and,tetany,secondary to,hypocalcemia,Erythematous,patches with,pustular,margin in flexural distribution,Sparing of face,hands,and feet,Postinflammatory,hyperpigmentation,common,Histopathologic,features identical to,pustular,psoriasis with spongiform pustules of,Kogoj,large collections of,neutrophils,within foci of,spongiotic,epidermis,Laboratory findings:Elevated leukocyte count and erythrocyte sedimentation rate,hypocalcemia,Treatment:,Prednisolone,30-40 mg daily,Prognosis:Stillbirth and placental insufficiency still frequently seen even when disease is apparently controlled.Remission 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 loss and vitamin K deficiency in severe cases,Usually,nonresponsive,to antihistamines and topical emollients,Histopathologic,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 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 secretion,Abnormal serum liver function tests(,LFTs,)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(PUPPP),妊娠多形疹,Incidence between 1 in 160 women and 1 in 300,Presents in,primiparous,women in third trimester or postpartum,Increased incidence in multiple pregnancy,Rare recurrence in subsequent pregnancies,Onset with,pruritus,within,striae,on abdomen;,periumbilical,sparing may occur,Clinically characterized by various lesions including,erythematous,plaques,papules,vesicles,purpura,and,erythema,multiforme,like lesions,Subsequent spread to breasts,upper thighs,and arms,sparing face,Serologic and,immunofluorescence,tests negative,Subtype described in which,IgM,deposition seen either on direct or indirect,immunofluorescence,Histopathologic,characteristics:,Spongiosis,in epidermis with,perivascular,or upper dermal chronic inflammatory cell infiltrate,Pathophysiology,:Unknown,although several theories including the role of sex hormones and abdominal wall distension caused by pregnancy,Prurigo,of,pregnancy,妊娠痒,疹,Described by,Besnier,in 1904,Incidence approximately 1 in 300,Similar to nodular,prurigo,seen in,nonpregnant,persons,Likely to be same eruption that Spangler described as,papular,dermatitis of pregnancy,Pruritic,papules on extensor aspects of limbs and on abdomen,Normal maternal and fetal prognosis,Histopathologic,features:Chronic inflammatory cell infiltrate in upper dermis with occasional epidermal features,Pathophysiology,:Unknown,although thought to be a result of physiologic,pruritus,in women with an,atopic,background,Treatment:Moderately potent topical corticosteroids,antihistamines,Prognosis:No adverse effects to mother or infant;resolution postpartum,Herpes,gestationis,妊娠疱疹,Autoimmune,bullous,disorder,closely related to,bullous,pemphigoid,(BP),Rare with incidence of approximately 1 in 60,000,Onset usually in second and third trimester or postpartum period,Recurrence common in subsequent pregnancy 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,bullae,Periumbilical,involvement in 87%of cases,Transplacental,transfer of antibodies can result in neonatal involvement,Associated with low birth weight and premature birth caused by placental insufficiency,Histopathologic,features:Similar to PEP in early phases;,subepidermal,separation with basal cell necrosis;,eosinophilic,spongiosis,Immunofluorescence,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 skin,Pathophysiology,:HLA-DR3,DR4 subtypes associated;close relationship to BP,sharing same target antigen BP-180,kd,(BP-AG2),a component of,hemidesmosomes,;anti-HLA antibodies found in serum of patients with PG,Treatment: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 therapy also leads to disease flare;,Goserelin,(LHRH,analogue)(chemical,oophorectomy,)used in severe cases in postpartum phase,Pruritic,folliculitis,of pregnancy,妊娠瘙痒性毛囊炎,Pruritic,erythematous,follicular papules and,urticarial,lesions on limbs and abdomen in most cases,Onset in second and third trimester with resolution within 2 to 3 weeks postpartum,Histopathologic,features:Acute,folliculitis,with mixed inflammatory cells,upper dermal edema and,spongiosis,;negative Grams stain,Pathophysiology,:Unknown;maternal androgens not implicated as previously suggested,Prognosis:Maternal and fetal outcome normal,