Prevalence of various dermatoses in pregnancy at a tertiary care centre in Moradabad, Uttar Pradesh, India: an observational study
Keywords:Eczema, EP, Herpes, PF, PP, Pregnancy skin lesions, Prurigo, Pruritic, PUPPP
Background: This was a prospective study which was done to observe various skin lesions in pregnancy and to determine the most likely causes and their incidence in antenatal patients, it was noticed that many women in our institute were having pregnancy related cutaneous complaints thus this observational study was carried out so that better preventive measures and treatment options could be provided to these patients.
Methods: Study was conducted in out-patient department of Obstetrics and Gynaecology, TMU, Moradabad. All ANC cases between October 2017 to September 2018 having any type of dermatoses were included in the study irrespective of gestational age. 6348 patients appeared in OPD in the given time period out of which 1256 were included. In case of pruritus, liver function tests were done with USG whole abdomen and patients were reviewed by physician if required. Screening with VDRL, HCV, HbSAg and ELISA for HIV was done in all. Results were tabulated and analyzed.
Results: 50.8% primi gravidas ,49.2% multi gravidas. age range 18-38 years. 29.3% presented in third trimester ,25.6% presented in second trimester. Physiological changes seen in all cases, 8.68% specific dermatoses of pregnancy. 40.4 % no complaints, 5.65% melasma, 90.8% hyperpigmentation, 94.6% linea nigra. Secondary areola 89.3%,striae 80.3% out of which 38.9%- primi gravidas and 41.40% -multi gravidas. 92.9% no change in hair density. Montgomery’s tubercles 30-50% of cases. spiders nevi 67%. No cases of palmar erythema. Pruritus gravidarum 38.53%. PUPPP 28.4%. Pemphigoid Gestationis 9.17%. Prurigo of pregnancy 18.34%. Pruritic folliculitis 1.8%. Eczema in pregnancy : pre-existing in 3.7% , out of which exacerbation 1, 3 unaffected. 3 chicken pox.1 filariasis.24 herpetic lesions (herpes simplex).1 scleroderma.17.27% pre-existing taenia infection . Scabies 20.46%.11 0.87% dual infection (scabies-taenia).
Conclusions: This study highlights high prevalence of community acquired infections in our region like taenia, scabies giving rise to skin lesions in Antenatal women. Moreover, it highlights a probable association between the prevalence of skin lesions with factors like poor personal hygiene, overcrowding, low socioeconomic status, anaemia and poor nutritional status.
Holmes RC, Black MM. The specific dermatoses of pregnancy. J Am Acad Dermatol. 1983;8(3):405-12.
Shornick JK. Dermatoses of pregnancy. Semin Cutan Med Surg. 1998;17(3):172-81.
Ambros-Rudolph CM, Mullegger RR, Vaughan-Jones SA, Kerl H, Black MM. The specific dermatoses of pregnancy revisited and reclassified: Results of a retrospective two-center study on 505 pregnant patients. Am Acad Dermatol. 2006;54(3):395-404.
Thomas RG, Liston WA. Clinical associations of striae gravidarum. J Obstet Gynaecol. 2004;24(3):270-1.
Chang AL, Agredano YZ, Kimball AB. Risk factors associated with striae gravidarum. J Am Acad Dermatol. 2004;51(6):881.
Torok HM, Jones T, Rich P, Smith S, Tschen E. Hydroquinone 4%, tretinoin 0.05%, fluocinolone acetonide 0.01%: a safe and efficacious 12-month treatment for melasma. Cutis. 2005;75(1):57-62.
Tunzi M,Gray GR. Common skin conditions during pregnancy.Am Fam Physician 2007;75(2):2118.
Daneshpazhooh M, Chams-Davatchi C, Valikhani M, Aghabagheri A, Mortazavizadeh SM, Barzegari M, et al. Pemphigus and pregnancy: A 23-year experience. Indian J Dermatol Venereol Leprol 2011;77(4):534.
Sachdeva S. The dermatoses of pregnancy. Indian J Dermatol 2008;53(3):103-5.
Cobo MF, Santi CG, Maruta CW, Aoki V. Pemphigoid gestationis: Clinical and laboratory evaluation. Clinics (Sao Paulo) 2009;64(11):1043-7.
Ruiz-Villaverde R, Blasco Melguizo J, Naranjo-Sintes R. Pigmentary demarcation lines in a pregnant Caucasian woman. Int J Dermatol 2004;43(12):911-2.
Kroumpouzos G, Cohen LM. Dermatoses of pregnancy. J Am Acad Dermatol 2001;45(1):1-19.
Roth MM: Pregnancy dermatoses: diagnosis, management, and controversies. Am J Clin Dermatol. 2011;12(1):25-41
Sceppa JA, Smith BL, Marghoob AA, Gottlieb GJ. Melanosis of the areola and nipple. J Am Acad Dermatol. 2008;59(1):S33-4.
Muallem MM, Rubeiz NG: Physiological and biological changes in pregnancy. Clin Dermatol 2006;24(2):80-4.
Oumeish OY, Al-Fouzan AS: Miscellaneous diseases affected by pregnancy. Clin Dermatol. 2006;24(2):113-7.
Vaughan Jones SA, Black MM: Pregnancy-related conditions. In Parish LC, Brenner S, Ramos-e-Silva M. Women's Dermatology: From infancy to maturity, pp 397-413. New York, Parthenon Publishing, 2001.
Salter SA, Kimball AB: Striae gravidarum. Clin Dermatol. 2005;24(2):97-100.
Higgins CA, Westgate GE, Jahoda CA. From telogen to exogen: mechanisms underlying formation and subsequent loss of the hair club fiber. J Invest Dermatol. 2009;129(9):2100-8.
Millikan L. Hirsutism postpartum telogen effluvium, and male pattern alopecia. Cosmet Dermatol 2006;5(1):81-6.
Matz H, Orion E, Wolf R: Pruiritic uritcarial papules and plaques of pregnancy: polymorphic eruption. Clin Dermatol 2005;24(2):105-8.
Ghazeeri G, Kibbi AG, Abbas O. Pruritic urticarial papules and plaques of pregnancy: epidemiological, clinical, and histopathological study of 18 cases from Lebanon. Int Dermatol 2012;51(9):1047-53.