Skin disorder in pregnancy Volume 2 - Issue 4

Myat San Yi¹*, Mi Mi Khaing¹ and Mon Mon Yee²

• ¹University of Malaysia, Malaysia
• ²Newcastle University, Malaysia

Received: July 22, 2019;   Published: July 30, 2019

Corresponding author: Myat San Yi, University of Malaysia, Sarawak, Malaysia

DOI: 10.32474/OAJRSD.2019.02.000143

Abstract PDF

Pregnancy is a turning point in women’s life. There are so many physiological changes preparing the mother to adapt to the fetus. The change in the woman’s immune system, with a shift from a predominantly T helper 1 lymphocyte profile to a T helper 2 profile, may underlie a woman’s susceptibility to skin disease [1]. There are other factors like endocrine, metabolic, mechanical, and vascular changes which influence on skin changes [2].

Skin is a barrier and a front-line defense against the invasion of microorganisms. Its integrity provides the physical barrier as it contains the important bioactive molecules such as defensins and Cathelicidins. The presence of the skin microbiota made up of microorganisms such as Staphylococcusepidermidis, Propionibacteria,Corynebacteria and negative Coagulase staphylococci play their role to prevent the invasion from various organisms[3].Still, the skin changes or diseases in pregnancy will challenge the medical professionals in primary care. It may be due to limited teaching in medical school over this specific area. Most practitioners including,we feel unprepared or unconfident once addressed to these cases.This short communication is intended to cover the physiological skin changes in pregnancy and to tackle the case with systematic history taking and competent clinical examination. These factors, together with appropriate laboratory tests, can help the clinician achieve the correct diagnosis, and point towards the identification of the underlying causative agent.

They are categorized into three types in general: normal physiological changes or benign skin conditions, exacerbations of preexisting conditions triggered by pregnancy, and specific dermatoses of pregnancy [4,5].The normal physiological changes are hyperpigmentation, hair changes, nail changes and pruritus gravidarum (common in the first and second trimester) and some glandular changes like increased activity in sweat glands and sebaceous glands. These changes are caused by increased secretion of pituitary Melanocyte- Stimulating hormone, steroids and pregnancy hormones such as estrogens and progesterone. The preexisting conditions like psoriasis improves in most of the cases. Eczema and atopy are commonly exacerbated by pregnancy. There are other skin conditions like acne vulgaris, scabies and fungal infection which may exacerbate during the pregnancy. The dermatoses of pregnancy are assumed to be developed from changes in immunologic, hormonal and metabolic system [6]. Their characteristics are summarized in the following (Table 1).

Table 1: Table of specific dermatoses of pregnancy.

Table 2: Highlights how to approach to the patient with skin disorder-Practical approach.

Tables 2 & 3) Dermatologists input is very important and helpful as skin biopsy for histopathological examination and immunofluorescence test to exclude specific skin disease. Treatment consists of simple measures like avoiding the irritants, applying emollients and symptomatic treatment like antihistamines. Steroids play an important role in the management. There are concerns over the safety of steroids usage in pregnancy. Recent evidence showed that there was no association between maternal use of topical steroids and orofacial cleft, preterm delivery or fetal death. There was a significant association between fetal growth restriction and maternal use of potent and ultra-potent topical steroids. Therefore, the recommendation is to use topical corticosteroids at the lowest potency possible to control the condition being treated. The risk of adverse effects increases with potency and the amount and length of time used [8-15].

Table 3: Shows the necessary laboratory tests to get the final diagnosis-Basic investigations.

In conclusion, interdisciplinary approach with involvement of obstetricians, paediatricians, dermatologists and physicians will lead to achieve the best outcome in their management. Early recognition, timely referral and adequate, effective treatment will reduce the short-term and long-term morbidity in both mother and foetus.

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