Skin diseases in non pregnant women are usually co incidental and not specific to pathology of the reproductive system. A gynecologist is not required to manage dermatological manifestations in women. An obstetrician does frequently encounter various dermatological conditions in their pregnant patients. The pregnant woman consults her obstetrician regarding all dermatological manifestations in pregnancy rather that visiting a dermatologist primarily. The obstetrician should therefore be aware about the various skin manifestations that may manifest in the gravid woman. These dermatological conditions may be either pre-existing, hormone induced or pregnancy specific.
Hormone induced changes that are commonly required to be dealt by the obstetricians include striae gravidarum, chloasma or melasma, skin pigmentation. The hyper-pigmentation tends to occur on the breast, vulva, linea alba, face, etc. These are usually physiological effects of pregnancy and they resolve or reduce in the post postpartum phase but may recur in future pregnancies. These are very distressing to the pregnant patient. Vascular changes under the effect of estrogen also tends to occur in some women like spider nevi, telangiectasias, palmar erythema, hemorrhoids, and varicosities.
Pre existing dermatological manifestations can include infections like candidiasis, tinea; eczema's, psoriasis, atopic dermatitis, etc. Conditions like atopic dermatitis or fungal infections worsen in pregnancy whereas diseases like psoriasis improve in pregnancy. Sometimes a condition may remain unaltered by pregnancy.
Pregnancy specific skin conditions are also known as dermatoses of pregnancy. These are seen only in pregnancy and are a heterogeneous, poorly defined, itchy, inflammatory cutaneous eruptions. These usually are seen in the antenatal period and usually settle down in the puerperium. These are intrahepatic cholestasis of pregnancy, pemphigoid gestationis, polymorphic eruptions of pregnancy and 3 conditions clubbed under atopic eruption of pregnancy. These 3 conditions included in atopic eruption of pregnancy are eczema in pregnancy, prurigo of pregnancy and pruritic folliculitis of pregnancy. The woman is distressed with persistent and repeated itching. Intrahepatic cholestasis of pregnancy and pemphigoid gestationis can adversely affect the fetus. In these pregnancies, fetal monitoring is needed to reduce the risk of fetal distress, morbidity and mortality.
When an obstetrician encounters a woman with skin lesions, a consultation with the dermatologist should always be sought in order to correctly establish a diagnosis and plan the treatment. Many of these women will require steroid based cutaneous preparations and some of them may even need systemic anti histaminic and steroid therapy. Patients with intrahepatic cholestasis of pregnancy will require treatment with bile acid binding substance like ursodeoxycholic acid. These women should not have a prolonged pregnancy and induction of labor may also be considered besides closer fetal surveillance.
At times an obstetrician also is required to be aware about the skin manifestations seen in the newborn. Most of the time these are insignificant occurrences and settle down, however, some of the skin conditions may be a pointer towards more serious inheritable conditions like epidermolysis bullosa.
An evaluation of the patient by a dermatologist is the best option and the patient should always be advised to consult a dermatologist.
We present one case in this issue where the gynecologist was called upon to manage a case of uterine fibroids which was actually a part of the Reed’s syndrome or the MCUL syndrome. In our previous issues the readers have read cases related to dermatological manifestations in pregnancy and in future also we will publish some more interesting cases associated with skin lesions which I am sure will be appreciated by our readers.With this I present the May issue to our esteemed readers.