We conducted a five-year retrospective study of 79 patients in a tertiary Spanish hospital. We observed a frequency of specific DP of 0.75% which is similar to others case series. PEP was the most frequent followed by AEP, ICP and PG and its rates are consistent with the literature [8, 6].
PEP occurs more frequently in primiparous women and multiple gestation pregnancy during the last weeks of pregnancy or immediate postpartum and male fetus [8, 10, 11]. It is associated with a higher abdominal distension in pregnant women, which can be explained by a higher incidence in multiple gestations [4, 8, 11, 12]. Overall the prognosis both of pregnant women and newborns is good. [6, 8, 12], Our study did not find more primaparous women affected (50%) but a higher frequency of multiple gestations (10.3%) occurrence in third trimester and immediate postpartum and a slightly higher ratio of male fetus (52%). Pruritus preceded the skin changes 1–2 weeks. Urticarial lesions set in the lower part of abdomen in all of patients, and in breasts and members in 20% of them. The prognosis was good in our series, and NI had a normal weigh, pH and APGAR.
The AEP is a benign pruritic dermatosis of unknown etiology that appears during first and second trimester. It is more frequent in multiparous women with atopic background or elevated IgE [6, 8, 10]. Typically, lesions are monomorphic papule-nodules or eczematous. [6, 8, 10, 11]. Diagnosis of AEP is clinical and supported by an elevation of IgE [8]. Biopsy is not specific and immunofluorescence is negative [6, 10, 11]. Papule-nodules can persist few months after delivery [8, 11]. AEP lasted more days than the others DP (mean of 11 days). It was not related to any comorbidity, as it is shown in other studies [8, 10, 11] although one suggest a slight decrease of NI weigh [13]. In our case series, there was a predominance of primiparous women (75%) in her second trimester; that makes sense when we think that AEP is more frequent in women with atopic backgroung or elevated IgE, so prompt to this disease. 20% of them had suffered from atopic dermatitis (Table 1). In all the cases, there were rubbing and scratching lesions due to the severe pruritus. In 8 patient’s lesions were predominantly type E (eczematous) whereas in 13 were type P (papules).
PG is an autoimmune bullous DP predominantly in the 2nd and 3rd trimester and/or immediate postpartum. Urticarial lesions became bullae due to the action of antibodies that binds the NC16A site of BP180-collagen XVII (an hemidesmosome protein) [10, 11]. Some authors described a predominance of PG in multiparous women [10] although it has not proved in other reports [8]. PG is associated with bad fetal prognosis [8, 12]. There was higher frequency of PG in the 2nd and 3rd trimester in our case series. All of them had very pruritic erythematous-edematous plaques that evolved to vesicles and bullae in periumbilical region, spreading to the rest of the body and affecting palms and soles [6, 8, 10, 11]. All the patients with PG in our study were primiparous with no predominance of any NI sex. Despite PG is associated with bad fetal prognosis, in our study PG only was associated with preterm delivery (40%) but with normal NI weigh, pH and APGAR. Occasionally, NI present bullae [8] as in one case that exhibited a self-limited vesicular eruption in scalp (Fig. 1).
ICP manifests as a generalized pruritus in the 3rd trimester presenting rubbing lesions. It usually starts in palms and soles and then affect the rest of the body [6, 8, 11]. It occurred in the third trimester and scratching signs were visible. Some authors indicated its association with multiple gestations [6]. It is well-known the defect of bile acids excretion in these patients [8]. Serum Bile acids, transaminases, and sometimes bilirubin, are elevated. [6, 8, 11]. Some studies showed a bad fetal prognosis due to respiratory distress in 12–22%, meconium in 25–45% and preterm delivery in 12–22% of cases, along with fetal death in utero and intracranial hemorrhage. We find that all the patients with ICP had pruritus in palms, 80% in soles and 30% generalized. We observed a predominance in primiparous women maybe because there are less multiparous women in our society, and no prevalence of any NI sex. We only observed preterm delivery in 30% of affected women. Apart from that, NI weigh, pH and APGAR were normal.