Deadly pregnancy complication: who is at risk

Dry skin during pregnancy is quite common. During gestation, the female body experiences serious stress and stress, so all organs work differently. A pregnant woman's body is rebuilt, which affects her appearance, in particular the properties of her skin. It becomes dry and flaky. Most often this appears on the hands, but dryness is also observed on the face, neck, stomach, and legs.

Peeling skin on the hands during pregnancy: causes

It should be understood that the problem of excessive dry skin is primarily caused by pregnancy itself and is completely natural.

1. Changes in hormonal balance

From the very beginning of pregnancy, the hormonal balance is disrupted:

• the level of the hormone progesterone increases, causing the skin to become sensitive, thin and less elastic;
• There is more estrogen hormone and the functioning of the sebaceous glands is disrupted, the secretion of sebum, which is necessary to nourish the skin, deteriorates.

These changes are inevitable, they occur in order for the mother’s body to accept the embryo, and if taken into account in advance, then with proper skin care it will be possible to prevent its excessive dryness.

• Lack of fluid

From a certain stage of pregnancy (second trimester), the usual volume of water consumed by a pregnant woman becomes insufficient. This is explained by an increase in the total blood volume, the formation of amniotic fluid and new tissues and organs of the unborn baby.

This takes up most of the liquid, and there simply isn’t enough of it to moisturize mommy’s skin.

• Thyroid dysfunction

A common disease for expectant mothers, hypothyroidism is caused by a lack of hormones produced by the thyroid gland and is often manifested by brittle hair, nails and peeling skin on the hands during pregnancy.

• Allergic reaction

The reason often affects the skin of the hands. This is due to the fact that the hands receive the most external influence, and it is more difficult to protect them: sun rays, chemical household products, frequent washing - all this adds to the increased sensitivity of the skin and leads to peeling and dry skin of the hands during pregnancy.

• Unbalanced diet

Insufficient intake of vitamins and microelements often affects the condition of the skin. Especially during pregnancy, when you need to eat for two. Vitamins A, E, B are responsible for moisturizing the skin.

• Stressful state

Against the backdrop of anxiety, a pregnant woman may experience irritation with itching and peeling of her hands. This is due to the increased sensitivity of the skin during this period, and, as a result, with an immediate reaction to any internal experiences.

How to care for dry skin during pregnancy?

Proper care of the face, hands, feet and body helps expectant mothers avoid discomfort and changes in skin condition. Various cosmetics and folk remedies tone, cleanse and nourish tissues. Proper care for dry skin consists of several rules:

• take baths with essential oils, glycerin, decoctions of flax seeds and oats;
• apply masks containing honey;
• rub sunflower oil, animal fats, butter into problem areas;
• wipe your face with milk;
• make compresses from infusions of calendula, chamomile or mint.

To eliminate rough skin on the elbows, arms, and feet, apply a rich cream or oil, wrap in plastic and a woolen scarf, and leave overnight. Rubbing flaxseed, sea buckthorn, and sunflower oils into the skin of the abdomen and thighs will help prevent the appearance of stretch marks. If used daily, the skin becomes moisturized and elastic.

When caring for your face, you need to remember the need for daily cleansing and applying moisturizer. You should avoid decorative cosmetics or limit their use to a minimum. The hands suffer the most from daily household chores. At night you should apply a nourishing cream or lubricate them with oil.

Cosmetics and procedures

Having learned about her situation, a woman should reconsider the cosmetic products she uses. It is imperative to remove those that dry out the skin of your hands and body: soaps, creams. Instead, purchase moisturizing and nourishing ones. It is better to use cream soap, shower gel, lotion, tonic, milk. You can use baby creams and natural oils. Products containing alcohol are not permitted. You definitely need to give up scrubs and peeling.

To eliminate dry face, special nourishing masks are recommended. Before using them, you need to make sure there is no allergy so as not to cause additional irritation.

When caring, special attention should be paid to problem areas of the skin: hands, elbows, knees. Nourishing oils and moisturizing creams with vitamins are suitable for this.

When choosing cosmetics, it is better to consult a gynecologist. He must confirm their safety for the baby and the absence of a negative reaction if the woman has concomitant diseases. If the dryness is very severe, accompanied by redness and itching, you should visit a dermatologist for a more thorough examination. He will prescribe treatment and suggest optimal care products. On the recommendation of a doctor, Bepanten, Panthenol, Pantoderm can be used to normalize the condition of the skin.

Folk recipes

There are many folk methods to get rid of dryness and moisturize the skin. Masks made independently from simple ingredients are always popular. They must be applied immediately after preparation. You cannot store the prepared mixture, as fresh products quickly lose their beneficial properties. After use, rinse well with warm water and apply cream. Recipes for face and body masks:

• Mix milk and honey in equal volumes. Apply to skin for 15-20 minutes. Instead of milk, you can use natural yogurt.
• Mix a glass of full-fat sour cream and vegetable oil, add an egg and the juice of half a lemon. Apply to problem areas and leave for 20-25 minutes. Optimal for rough areas – feet, elbows.
• Grind the avocado into a pulp, add 1 tsp. honey and yogurt. Leave on face for 20 minutes. Avocado essential oils penetrate deep into tissues, nourishing them from the inside.
• Mix 2 tsp. cottage cheese and flaxseed oil, 1 tsp each. parsley juice and fish oil, a little orange zest. Keep on skin for 10 minutes.
• Cook milk oatmeal, add yolk and avocado oil. Apply for 10 minutes.
• Take 4 drops of vitamins A and E (sold in liquid form at the pharmacy), add 2 tbsp. l. oat flour (crushed oats) and olive oil. Apply the mask to the skin for 20 minutes. Suitable for all parts of the body. After several uses, the skin is saturated with vitamins, moisturized, and acquires a healthy appearance and elasticity.

Nutrition correction

During pregnancy, the condition of the skin almost always changes. To prevent it from flaking, turning red, or becoming dry, you need to eat right and maintain water balance. The importance of water is invaluable, because it is required for the development and growth of the child in the womb. The doctor will tell you the norms of water consumption at each stage of pregnancy:

• From the moment of conception, drink 2 liters of water per day. Soups, liquid dishes, foods containing a lot of liquid (cucumbers, watermelons), tea, coffee are not included in this norm.
• After 25-30 weeks, fluid intake is limited to avoid swelling. You should drink no more than 1 liter of clean water per day. You can't drink at night.

Food has a huge impact on the condition of the skin. They provide the bulk of vitamins, minerals and nutrients necessary for the development of the child and nourishment of the mother's body.

You need to eat correctly, adhering to the basic principles:

• do not eat everything in a row and observe moderation;
• consume more fruits, vegetables, protein and other healthy foods;
• introduce foods rich in omega-3 and omega-6 acids into your diet: seafood, seeds, nuts, vegetable oils;
• reduce the consumption of spicy, smoked, fatty foods, chocolate, sweet carbonated drinks;
• follow a diet: eat at certain hours, with equal frequency;
• do not snack on heavy and unhealthy foods.

In the second half of pregnancy, you need to be more careful about your diet. Due to changes in hormonal balance, an allergic reaction may occur to foods with which there were no problems before.

The skin on the hands cracks during pregnancy: what is the danger?

In fact, there is nothing wrong with dry skin – especially when the problem is not accompanied by any other symptoms. However, peeling hands during pregnancy and itchy skin cause the expectant mother a lot of unpleasant sensations. And if they are not eliminated in a timely manner, the situation may worsen: dry skin on the hands will crack, water will constantly get into the micro-wounds when washing hands, an infection may even develop, and inflammation will begin. All this is extremely unpleasant and already dangerous.

Therefore, it is important to properly care for your skin during pregnancy and be sure to report the problem to your doctor during a routine examination. If necessary, he will prescribe tests and refer you to a specialized specialist.

Should you report your symptoms to your doctor?

Any change in condition during pregnancy should not be overlooked. It is imperative to inform your doctor about dry skin, despite the fact that this is a common occurrence for a pregnant woman. He will identify the cause and prescribe methods to eliminate it, which may include:

• change in the amount of fluid consumed;
• nutrition correction;
• taking vitamin complexes;
• use of special creams and other cosmetics.

Dryness is caused not only by the listed reasons, but also by some diseases or allergic reactions. The doctor must conduct an examination to promptly detect and eliminate them. A missed allergy can be passed on to the child.

What to do when the skin on your hands dries during pregnancy

Your hand skin will be less dry if:

How to get rid of dry skin during pregnancy

Dry skin during pregnancy can be a temporary phenomenon, but it can also serve as a symptom of endocrine disorders, so it cannot be completely ignored.

Recommended

1. Normalization of drinking regime . Only together with an obstetrician-gynecologist, to exclude swelling and dropsy of pregnancy.
2. Consultation with an endocrinologist with a mandatory blood test for hormones to rule out hypothyroidism or diabetes during pregnancy.
3. Replacing/selecting a cleanser with a more gentle one (milk, non-foaming gel).
4. Selection of care products : daily use of a serum containing micronized hyaluronic acid, on top of which a nourishing, regenerating cream is applied.

Experts' opinion

The conducted clinical study proves the high efficiency, safety and tolerability of the product for daily skin care of children with mild and moderate forms of atopic dermatitis and during remission, accompanied by a decrease in the quality of life of patients. As a result of therapy, a decrease in the activity of the inflammatory process, a decrease in dryness, itching and flaking was noted.

Researchers from the Vertex company have proven that as a result of using La-Cri cream for sensitive skin, itching and irritation are significantly reduced, and redness goes away. The cream carefully cares for the skin and perfectly moisturizes it.

Based on the results of a clinical study, the information “Recommended by the St. Petersburg Branch of the Union of Pediatricians of Russia” is placed on product packaging.

Sources:

1. I.I. Ryumina, V.V. Zubkov, Newborn skin care, Healthy Child magazine, 2017
2. Habiff Thomas P., Clinical Dermatology. Acne-like and papulosquamous dermatoses, publishing house: MEDpress-inform, 2014
3. Churolinov Petr, Herbal medicine in dermatology and cosmetics, Medicine and Physical Education Publishing House, 1979

Photos of eczema

Examples of cosmetics

The main problem that arises when dealing with dry skin during pregnancy is the selection of not only effective, but also safe products for girls in an interesting position.

There are a number of ingredients that are strictly not recommended for use during pregnancy and lactation:

• Vitamin A (retinol palmitate, retinaldehyde, retinoic acid)
• Salicylic acid
• Benzoyl peroxide

List of approved drugs DermaQuest

Let's consider the main positions necessary to combat dry skin:

Cleansers

Cleansing milk for delicate skin is the optimal solution for combating dryness and dehydration of the skin during the cleansing stage.

• Light texture milky cleanser
• Natural composition without dyes or artificial flavors
• Effectively dissolves and removes impurities and makeup from the skin surface
• Does not break skin barriers, on the contrary, restores them with Jojoba, Shea and mango seed oils
• Relieves skin irritation

Contains antioxidants and moisturizing ingredients

After use, the skin feels clean and moisturized at the same time!

Facial cleansing gel, daily care – a delicate enzyme-based cleansing gel for all skin types: quickly removes makeup and impurities, can be used around the eyes.

• Does not contain aggressive surfactants, does not foam during use
• Gently cleanses the skin with plant enzymes
• Dissolves and removes makeup
• Restores and moisturizes the skin due to the content of Aloe and Vitamin E

Hypoallergenic and acid-free composition is suitable for all skin types and during pregnancy.

Moisturizing serums

Serum B5 moisturizing with hyaluronic acid is a universal, powerful moisturizing serum. Contains 40% hyaluronic acid, designed for dry and dehydrated skin of all types.

• 40% micronized hyaluronic acid
• Patented moisturizing complexes: Protective Moisturizer Complex and Moisturizing Phytoamine Biocomplex.
• Complexes that increase the synthesis of your own collagen and hyaluronic acid: Aktifirm TS and MDI Complex.
• Panthenol 5%

Serum B5 moisturizing mattifying for oily skin - moisturizing serum for oily/combination/problem skin with signs of dehydration.

• 20% micronized hyaluronic acid
• Lilac Lilac stem cells, AC.NETTM complex and Evermat TM - have a sebum-regulating effect, normalize the amount and composition of sebum. Act locally at the site of application.

Serums have a light transparent gel texture; use 2 times a day, morning and evening.

There are three main categories of pregnancy-related skin conditions: (1) benign skin conditions caused by natural hormonal changes, (2) pre-existing skin conditions whose course changes during pregnancy, and (3) pregnancy-specific dermatoses. In some cases, these categories may overlap.

KEY RECOMMENDATIONS FOR PRACTICAL APPLICATION

Benign skin diseases

Skin conditions caused by natural hormonal changes during pregnancy include striae gravidarum, hyperpigmentation, and changes in hair, nails, and blood vessels.

STRIPS IN PREGNANT

Striae gravidarum (stretch marks) occur in 90 percent of pregnant women by the third trimester (Figure 1) (1, 2). Striae appear as pink-purple atrophic lines or stripes on the abdomen, buttocks, breasts, thighs, or arms. They are more common in young women, women with large pregnancies, and women with higher body weights (3).

Women with dark skin who have a history of stretch marks on the chest or thighs, or a family history of stretch marks of pregnancy, are also at higher risk (4).

The cause of striae is multifactorial and includes physical factors (eg, actual stretching of the skin) and hormonal factors (eg, the effect of adrenal hormones, estrogen and relaxin on the elastin fibers of the dermis).

Numerous creams, emollients, and oils (eg, vitamin E cream, cocoa butter, aloe vera lotion, olive oil) are used to prevent stretch marks; however, there is no evidence that these treatments are effective. Limited evidence suggests that two topical medications may help prevent striae (5).

One contains Centella Asiatica extract plus alpha-tocopherol and collagen and elastin hydrolysates. Another product contains tocopherol, essential fatty acids, panthenol, hyaluronic acid, elastin and menthol.

However, none of these drugs are widely available, and the safety of using centella asiatica during pregnancy and the components responsible for their effectiveness are unclear (6).

Further research is needed before these treatments and commonly used creams and emollients can be recommended for widespread use.

Most stretch marks regress to pale or flesh-colored lines and improve after childbirth, although they usually do not disappear completely. Treatment is nonspecific and there is a limited evidence base.

Postpartum treatment includes topical tretinoin therapy (Retin-A) or oral tretinoin therapy (Vesanoid) (U.S. Food and Drug Administration pregnancy categories C and D, respectively; safety unknown in breastfeeding women) and laser therapy (585 nm, pulsed dye laser) (7, 8).

HYPERPIGMENTATION

Almost all women experience some form of hyperpigmentation during pregnancy. These changes are usually more pronounced in women with darker skin.

The areas most commonly affected are the nipple areola, armpits, and genitals, although scars and nevi may also become pigmented. The linea nigra is a line that often forms when the linea alba darkens during pregnancy.

Melasma (chloasma or mask of pregnancy) may be the most cosmetically problematic skin condition associated with pregnancy (Figure 2). Up to 70 percent of pregnant women have this condition (1), and it can also occur in women taking oral contraceptives.

Exposure to sunlight and other types of ultraviolet radiation worsens melasma; Therefore, using highly effective broad-spectrum sunscreens (against UVA and UVA) and avoiding overexposure to sunlight may prevent the development or worsening of melasma (1, 2).

Although no specific treatment is prescribed during pregnancy, doctors can reassure patients that melasma in most cases goes away after childbirth. However, it may not resolve completely and may recur in future pregnancies or with the use of oral contraceptives (1, 2).

Severe postpartum epidermal melasma is usually treated with combinations of topical tretinoin, hydroquinone (Eldoquin Forte), and corticosteroids (9, 10).

CHANGES IN HAIR AND NAILS

An increase or decrease in hair growth is common during pregnancy (1, 2, 11). Many women have manifestations of hirsutism on the face, limbs and back, caused by endocrine changes during pregnancy.

Hirsutism usually resolves after childbirth, although cosmetic correction may be considered if the condition persists. Pregnant women may also notice a slight thickening of the hair on their scalp. This is caused by the prolonged active (anagen) phase of hair growth.

After childbirth, scalp hair enters a long resting phase (telogen) of hair growth and increased shedding (telogen hair loss) occurs, which can continue for several months or more than a year after pregnancy (12).

A few women prone to androgenetic alopecia may notice frontoparietal hair loss, which may not go away after pregnancy.

Nails usually grow faster during pregnancy. Pregnant women may experience increased fragility, transverse grooves, onycholysis, and subungual hyperkeratosis (1, 2, 11). Most of these conditions resolve after delivery, and doctors can explain this to patients and recommend adequate nail care.

VASCULAR CHANGES

Natural changes in estrogen production during pregnancy can cause dilation, instability, proliferation, and blockage of blood vessels. Most of these vascular changes resolve after delivery (1).

Spider telangiectasias (spider nevi or spider angiomas) occur in approximately two-thirds of pregnant women with light skin phototypes and 10 percent of pregnant women with dark skin phototypes, mainly on the face, neck and arms. This condition most often occurs in the first and second trimesters of pregnancy (1, 2, 11).

Palmar erythema occurs in approximately two thirds of pregnant women with light skin phototypes and up to one third of pregnant women with dark skin phototypes. Subcutaneous, vulvar, or hemorrhoidal varicose veins occur in approximately 40 percent of pregnant women (1, 2, 11).

Vascular changes combined with increased blood volume can cause increased “outflow,” leading to persistent swelling of the face, eyelids, and extremities in up to half of pregnant women (1, 11).

Increased blood flow and pelvic vascular instability can cause vaginal erythema (Chadwick's sign) and a bluish discoloration of the cervix (Goodell's sign) (1).

Vasomotor disturbances can also cause facial flushing; dermatographism; sensations of heat and cold; and manifestations of marbled skin, a condition characterized by a bluish tint to the skin due to an excessive reaction to cold (2).

All pregnant women experience hyperemia and swelling of the gums, which can cause gingivitis and bleeding, especially in the third trimester (1, 11).

Pyogenic granulomas may appear late in the first trimester or in the second trimester as dark red or purple nodules on the gums or, less commonly, on other areas of the skin.

In most patients, observation is advisable because these lesions usually regress after delivery. However, if bleeding occurs, surgical treatment and possible excision may be indicated (1, 2, 11).

Previously existing skin diseases

Pre-existing skin conditions (eg, atopic dermatitis; psoriasis; candidiasis and other fungal infections; skin tumors, including malignant melanoma) may change during pregnancy.

Atopic dermatitis and psoriasis may worsen or improve during pregnancy. Atopic eruptions may be associated with prurigo gravidarum and usually worsen over time but may improve during pregnancy (13).

Psoriasis often improves as it progresses. Fungal infections usually require a longer course of treatment during pregnancy (14).

Soft tissue fibroids can occur on the face, neck, upper chest, and under the breasts during late pregnancy. These fibroids usually disappear after childbirth (1).

The impact of pregnancy on the development and prognosis of malignant melanoma has been widely debated; however, a recent retrospective cohort study of pregnant women with melanoma provided no evidence that pregnancy affects survival (16).

Dermatological diseases typical for pregnant women

True dermatoses of pregnancy (Table 1) (17, 23) include pruritic urticarial papules and plaques of pregnancy (PUPPP), pruritus of pregnancy, intrahepatic cholestasis of pregnancy, pemphigoid of pregnancy, impetigo herpetiformis, and pruritic folliculitis of pregnancy.

TABLE 1 . Dermatological diseases characteristic of pregnancy

PUPPP

PUPPP (Figure 3) is the most common pregnancy-specific dermatosis, occurring in one in 130–300 pregnant women (1).

The PUPPP-associated rash, characterized by intense itching, develops in the third trimester and usually appears first on the abdomen, often along stretch marks (17).

This disorder is more common in first pregnancies and multiple pregnancies, and familial cases have also been reported (18).

Despite its frequency, the etiology of PUPPP remains unclear. A relationship has been suggested between this disease and disturbances in the interaction between the maternal immune system and fetal tissues (24).

The increased incidence in women with multiple pregnancies suggests that skin stretching may play a role in triggering an immune-mediated reaction. Histopathological findings are nonspecific (18).

There is no specific treatment for PUPPP and it is not associated with adverse pregnancy outcomes.

Antihistamines and topical steroids can be used to treat itching, and systemic corticosteroids can be used for severe itching (18). The rash usually goes away within one to two weeks after delivery.

Prurigo of pregnant women

Prurigo in pregnancy (Fig. 4.) occurs in approximately one in 300 pregnant women and is recorded in all trimesters (1). It is not uncommon for a pregnant woman to experience prolonged itching that persists for weeks or months after giving birth (1).

The cause of this disease is unclear, and there are no significant adverse effects on the mother or fetus. An association with intrahepatic cholestasis during pregnancy or a history of atopy has been suggested (18). Mild-strength topical steroids and oral antihistamines may provide symptomatic relief.

INTRAHEPATIC CHOLESTASIS IN PREGNANCY

Intrahepatic cholestasis of pregnancy has historically been called pruritus of pregnancy because its classic presentation is severe itching in the third trimester. Intrahepatic cholestasis of pregnancy occurs in one in 146 to 1293 pregnant women in the United States (1).

The diagnosis is based on the clinical picture and history: itching with or without jaundice, the absence of primary elements of a skin rash and laboratory markers of cholestasis. This condition usually resolves after childbirth (1, 18, 19).

Laboratory markers include elevated serum bile acid levels (4.08 μg per mL [10 μmol per L] or more) and alkaline phosphatase levels with or without elevated bilirubin levels (25).

However, alkaline phosphatase levels are typically elevated in pregnant women, limiting the value of this test (19).

Aspartate aminotransferase and alanaminotransferase levels and other liver function tests may be slightly altered. Cholestasis and jaundice in patients with severe or prolonged intrahepatic cholestasis during pregnancy may cause vitamin K deficiency and coagulopathy (18).

The etiology of intrahepatic cholestasis during pregnancy remains controversial. Family history of the disease is common, and there is an association with the presence of human leukocyte antigen-A31 (HLA-A31) and HLA-B8 (1, 18).

This condition tends to recur in subsequent pregnancies (1). Patients may have a family history of gallstone disease and a higher risk of gallstone formation (25, 26).

This condition is associated with a higher risk of preterm birth and rupture of meconium-stained fluid and fetal death.

A prospective cohort study demonstrated a correlation between bile acid levels and fetal complications, with a statistically significant increase in adverse fetal outcomes reported in patients with bile acid levels of 16.34 μg per mL (40 μmol per L) or more (25).

For patients with mild itching, oral antihistamines may be prescribed. Patients with more severe cases require ursodeoxycholic acid (ursodiol [Actigall]) to relieve pruritus and reduce cholestasis while reducing the risk of adverse fetal outcomes (18, 27).

Current data do not support the effectiveness of therapy with S-adenosylmethionine, anion exchange resins (eg, cholestyramine [Questran]), or corticosteroids (18, 28).

Patients should undergo in-depth prenatal care at diagnosis, and some recommendations recommend delivery before 38 weeks of pregnancy. The effect of early delivery on perinatal complications has not been proven (29).

PEMPHIGOID IN PREGNANT

Gestational pemphigoid (Figure 5), sometimes called gestational herpes, is an autoimmune skin disease that occurs in one in 50,000 mid- to late-term pregnancies (20).

Pemphigoid gravidarum is associated with the presence of HLA-DR3 and HLA-DR4 and is rarely associated with molar pregnancy and choriocarcinoma (18, 21). Patients with a history of this disease have an increased risk of other autoimmune diseases (eg, Graves' disease) (30).

The disease can occur in different ways, although its course usually improves in late pregnancy with exacerbations in the immediate postpartum period. Exacerbations have been associated with oral contraceptive use and are common in subsequent pregnancies (18).

Immunodiagnostic studies reveal characteristic deposits of complement C3 along the dermoepidermal junction (30). The risk to the fetus has not been confirmed, although immunoglobulin G autoantibodies cross the placenta, and 5 to 10 percent of newborns have urticarial, vesicular, or bullous lesions (30).

Mild placental insufficiency has been associated with preterm birth and small gestational age neonates. Therefore, antenatal care should be considered (22).

Patients with mild forms of pemphigoid of pregnancy may respond to oral antihistamines and systemic topical corticosteroids, while patients with more severe symptoms may require oral corticosteroids.

HERPETIFORM IMPETIGO

Impetigo herpetiformis (Figure 6), a form of pustular psoriasis, is a rare skin disease that appears in the second half of pregnancy. Whether this disorder is specific to pregnancy or simply exacerbated by it remains controversial (1).

Systemic signs and symptoms of impetigo herpetiformis include nausea, vomiting, diarrhea, fever, chills, and lymphadenopathy. There is usually no itching. Complications (eg, secondary infection, septicemia, hyperparathyroidism with hypocalcemia, hypoalbuminemia) may occur (1).

Treatment of impetigo herpetiformis includes systemic corticosteroids and antibiotics to treat secondary infected lesions. Prednisolone may be required at a dose of 15 to 30 mg to 50 to 60 mg per day, followed by a slow dose reduction (1, 22, 23).

The disease usually resolves after childbirth, although it may recur during subsequent pregnancies. The degree of risk to the fetus is somewhat controversial; however, an increase in fetal morbidity has been reported, suggesting the need for increased prenatal care (22).

ITCHY FOLLICULITIS OF PREGNANCY

Pruritic folliculitis of pregnancy occurs in the second and third trimesters and manifests as erythematous follicular papules and sterile pustules.

Contrary to its name, itching is not the main symptom. Spontaneous resolution occurs after childbirth. This condition is likely underdiagnosed because it is often misdiagnosed as bacterial folliculitis (18).

The etiology of pruritic folliculitis of pregnancy is unclear, and there are no reports of adverse fetal outcomes clearly associated with this condition. Treatment includes topical corticosteroids, topical benzoyl peroxide (Benzac), and ultraviolet B therapy (1).

How does the disease manifest during pregnancy?

The disease is quite easy to recognize by severe itching and red rashes that appear on the stomach, knees, elbows, chest and neck. When active, the rash looks like small blisters with liquid contents. When they burst, areas of weeping appear on the skin, which then dry out and peel.

Scratching causes the skin to thicken and become rough. This phenomenon is called lichenification. The effect on the fetus of atopic dermatitis during pregnancy is minimal. The disease brings more discomfort to the woman herself, without interfering with the development of the child. Consequences can occur after birth, since the tendency to atopy is inherited. In a child, it can manifest itself not only in the form of dermatitis, but also in the form of bronchial asthma or hay fever.