1 / 22

妊娠皮膚病簡介

妊娠皮膚病簡介. 生理的變化. Enlarged of the intermediate lobe of the pituitary gland , the melanocyte-stimulating hormone (MSH) became remarkably elevated by 8 weeks gestation. 常見的變化 -Hyperpigmentation. 90% : skin darkening ; MSH and estrogen

bert-davis
Download Presentation

妊娠皮膚病簡介

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. 妊娠皮膚病簡介

  2. 生理的變化 • Enlarged of the intermediate lobe of the pituitary gland , the melanocyte-stimulating hormone (MSH) became remarkably elevated by 8 weeks gestation

  3. 常見的變化-Hyperpigmentation • 90% : skin darkening ; MSH and estrogen • Beginning early in pregnancy and more pronounced in naturally hyperpigmented areas such as areolare , perineum and umbilicus and axillae and inner thigns, Linea nigra • Face: cholasma or melasma ; 50% , sunscreens ; Regress postpartum , dermal melanosis persist up to 10 years in 1/3 pts • 2-5% hydroxquinone , 0.1% tretinoin gel or cream or 20% azelaic acid cream

  4. cholasma or melasma 黑斑 or 肝斑 Linea nigra

  5. 常見的變化-Navi • Pigmented cutaneous tumors commonly enlarge and darken during pregnancy , leading to their confusion with malignant melanomas. • 6% changed in diameter over pregnancy • No evidence that they undergo malignant transformations

  6. 常見的變化-Hair Growth • Growing hair phase is increased related to the resting hair phase • Estrogen prolong the growing hair phase and androgens cause enlargement of follicles • Telogen effluvium: abrupt hair loss beginning 1 to 4 months postpartum ; self limited and restored in 6 to 12 months

  7. 常見的變化-Vascular change • Augmented cutaenous blood flow: estrogen and decreased vascular resistance • Spider angiomas : 2/3 white and 1/10 black • Palmar erythema : 2/3 white and 1/3 black • Papillary hemangiomas: 5% • Pregnancy gingivitis (epulis): growth of the gum capillaries • Pyogenic granuloma of pregnancy (granuloma gravidarum) : oral cavity and arise from the gingival papillae

  8. Spider angiomas Palmar erythema

  9. Pyogenic granuloma of pregnancy Pregnancy gingivitis (epulis)

  10. 妊娠紋 • 80～90﹪的孕婦 • 懷孕6～7個月後開始產生，除了肚子之外，大腿、腹股溝甚至胸部都有可能出現粉紅或紫紅色萎縮性斑紋。 • 除了荷爾蒙的影響，體重增加太快也是促成原因之一。 • 雖然在產後會慢慢變白、變細， 但很多人是無法完全恢復的 • 控制體重 • 含果酸的乳液或其他可促進 彈力纖維生成的妊娠霜，來緊緻皮膚， 預防妊娠紋產生。倘若妊娠紋已產生 ，在產後且妊娠紋尚未變白前， 可接受脈衝光治療，有改善的機會。

  11. Dermatoses of pregnancy • 1.6 % of women had significant pruritus at some time during prengancy • Pruritus gravidarum • Prurutuc ureticarial papules and plaques of pregnancy • Herpes gestationis

  12. Pruritus Gravidarum • 0.6% pregnancy with pruritus : mild variant of intrahepatic cholestasis of pregnancy • Scratching and excoriation  skin lesions • Hormone,genetics and enviornmental factors

  13. Pruritic urticarial papules and plaques of pregnancy • PUPPP in US ; Polymorphic eruption of pregnancy (PEP) in UK • 1/200 singleton , 8/200 for twin • Pruritic cutaneous eruption that usually appears late in pregnancy ; abdomen firstly and then buttocks and thighs and extremities. • 40%: urticarial ; 45% erythematous pattern ; 15% combination; face spared and common in nulliparas and seldom recurs in subsequent pregnancy . • Resemble herpes gestationis but no veiscles or bullae

  14. Prurigo of pregnancy • Papular eruptions of pregnancy • Prurigo gestationis and papular dermatitis • Prurigo gestationis : small pruritic , rapidly excoriated lesions on the forearms and trunk • No vesicles or bullae • Onset at 25 to 30 weeks and may persist for 3 months after delivery • Recurrence is common • Oral antihistamines and topical corticosteriod creams • Perinatal outcome : not affected

  15. Herpes gestationis (1) • Noninfectious disorder • Autoimmue pruritic blistering skin eruption affects multiparous women in late pregnancy and may begin early in pregnancy or within a week or postpartum • Pemphioid gestationis : immunologically similar to bullous pemphgoid • 1/5000 pregnancies • Extremely pruritic widespread eruption with lesions that vary from erythematous and edematous papules to large , tense vesicles and bullae.

  16. Herpes gestationis (2) • Topical corticosterioids and oral antihistamines • Orally pregnisone 0.5 to 1 mg/kg daily , brings relief and inhibits formation of new lesions • The healed sites are not scarred but frequently are hyperpigmented • Refractory cases: immunosuppresives , such as cyclophosphamide , methotrexazte and cyclosporine. • Bullous pemphigoid : plasmapheresis and high dose IG therapy

  17. Herpes gestationis (3) • Reports of association with preterm birth , stillbirths and growth restriction • Increased surveillance is recommended • Lesions similar to those of the mother develop in up to 10% of neonates

  18. Preexisting skin disease • Acne: Isotretinoin , etretinate and tretinoin are strictly contradicted in pregnancy – teratogenic • Pregnancy : topically applied benzoyl peroxide and clindamycin or erythromycin gel • Topical tretinoin is thought to pose no significant teratogenic risk

  19. Preexisting skin disease(2) • Psoriasis improves in up to 50% during pregnancy and 20 % worse • Localized : Topical corticosteroids calciportriene , antrhalin and tacrolimus • Generalized mild disease: UV-B phtotherapy or plus psoralens and oral cyclosporing if unsuccessful • Moderate and severe: plus topical or oral corticosteriods • Coal tar derviatives as well as oral and systemic immunosupressives ( MTX, cyclosporine , tacrolimus) are avoided

  20. Thank you for your attention

More Related