ATOPIC ERUPTION OF PREGNANCY
- Nonspecific eczema and prurigo-like lesions.
- Elevated IgE in 20-70%.
- Diagnosis is clinical. DIF if performed is negative.
- Treatment is with emollients, topical steroids, oral antihistamines and, if needed, narrowband UVB.
- Expect resolution with delivery, but activity may persist up to 3 months postpartum.
- There is no impact on mom or baby.
- Recurrence may occur with subsequent pregnancies.
This condition has gone by various names including prurigo of pregnancy, prurigo gestationis, early-onset prurigo of pregnancy, Spangler's papular dermatitis of pregnancy, pruritic folliculitis of pregnancy, and eczema of pregnancy. The baby is unaffected, but may be at increased risk for atopic dermatitis. Indeed, a family history of atopy (asthma? hay fever? allergies? eczema?) is frequently observed.
Onset is usually in the first or second trimester. There may be erythematous, eczematous areas in the flexures. Alternatively, papular, pruritic lesions may occur on the abdomen and extremities. Dermatographism may be associated. Scabies should be excluded.
A topical steroid such as triamcinolone may be started initially along with Benadryl 25 mg Q4-6 hours. If not sufficient, a higher steroid may be given with permission from OB. They are more willing to allow such treatment later in the pregnancy. Hydroxyzine 25 mg q4-6 hours may also be given.
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