Common Skin Rashes in Pregnancy

PEP or PUPPP is a relatively common skin problem in pregnant women. It usually affects first pregnancies and occurs towards the end of the third trimester or immediately after delivery.

Eczema is a very common condition in pregnant and non-pregnant women. It can present for the first time during pregnancy and can occur at any stage during pregnancy.

Patients usually have a personal or family history of other atopic conditions, such as asthma or allergic rhinitis.

INTRAHEPATIC CHOLESTASIS OF PREGNANCY (ICP):

Intrahepatic cholestasis of pregnancy (ICP) is a potentially serious liver disorder that can develop in pregnancy. Normally, bile acids flow from your liver to your gut to help you digest food. In ICP, the bile acids do not flow properly and build up in your body instead.

ICP can run in families, but it can happen even if there is no family history.

If you have had ICP in a previous pregnancy, you have a high chance of developing it again in another pregnancy

Some studies have found that babies whose mothers have ICP have a higher chance of being born prematurely or stillborn.

Patients present with itchy, red rashes that usually start from the stretch marks on the abdomen, which can then spread over the trunk, thighs and arms. It may also appear as raised lumps/ patches of different shapes and sizes.

Rarely, blisters may develop in severe cases. If blistering is severe, a skin biopsy may be required to rule out another more serious blistering condition that can occur in pregnancy (pemphigoid gestationis).

PUPPP is not known to harm mother or baby and it usually resolves within one to two months after delivery. It rarely recurs in subsequent pregnancies.

Patients present with red, inflamed and scaly patches with scratch marks (excoriations). It may become weepy and oozy if there is secondary infection.

The common sites involved are the abdomen, folds over the limbs, neck and face.

If inadequately untreated, the skin can become thickened with prominent creases (lichen simplex chronicus) and larger lumps (prurigo nodules).

The condition is not known to affect the health of the baby. Some patient’s condition may improve after delivery; while some may go on to have chronic eczema.

The main symptom of ICP is itching, usually without a rash. The itching is often more noticeable on the hands and feet but can be all over the body. It is usually worse at night.

Symptoms of ICP typically start from around 30 weeks of pregnancy, but it's possible to develop the condition as early as 8 weeks.

Treatment is usually symptomatic relief with topical emollients, topical corticosteroids and oral anti-histamines. A short course of oral steroids may be required in severe cases.

The condition will spontaneously resolve after delivery. Sometimes, there may be a flare a few days after delivery before spontaneously resolving.

Treatment involves daily skin care with a gentle soap or soap substitute, and frequent application of topical emollients.

Topical corticosteroids are to be applied on affected skin, and are safe in pregnancy.

If there are signs of infection, topical or oral antibiotics may be prescribed.

Oral antihistamines are useful to reduce itch and help with sleep.

Treatment involves daily skin care with a gentle soap or soap substitute and application of topical emollients.

Anti-itch creams containing menthol (e.g. Suu Balm), is safe for use in pregnancy and can provide relief from itching.

Oral ursodeoxycholic acid can help to reduce bile acids and ease itching.

If you are diagnosed with ICP, your obstetrician will discuss your health and your options with you.