Pruritic Rash in Pregnancy
Am Fam Physician. 2017 Apr 1;95(7):453-454.
A 29-year-old woman (gravida 4, para 2) presented at 29 weeks' gestation with the sudden appearance of scattered periumbilical and lower extremity pruritic papules. Despite treatment with topical hydrocortisone valerate and oral diphenhydramine (Benadryl), the rash spread to her entire abdomen and all four extremities. Physical examination revealed ovoid plaques with targetoid features and erythematous nodules (Figures 1 and 2). Her face and mucous membranes were not affected.
The pruritus intensified, and her symptoms did not respond to an increased dose of topical or oral corticosteroids. Her medical and obstetric histories were unremarkable, including no history of similar rashes. She had no new exposures. A skin biopsy revealed prominent linear staining of the epidermal basement membrane for C3 and lesser staining for immunoglobulin G (IgG).
Based on the patient's history, physical examination, and histologic findings, which one of the following is the most likely diagnosis?
A. Intrahepatic cholestasis of pregnancy.
B. Pemphigoid gestationis.
C. Prurigo gestationis.
D. Pruritic urticarial papules and plaques of
REFERENCESshow all references
1. Bedocs PM, Kumar V, Mahon MJ. Pemphigoid gestationis: a rare case and review. Arch Gynecol Obstet. 2009;279(2):235–238....
2. Jenkins RE, Hern S, Black MM. Clinical features and management of 87 patients with pemphigoid gestationis. Clin Exp Dermatol. 1999;24(4):255–259.
3. Bergman H, Melamed N, Koren G. Pruritus in pregnancy: treatment of dermatoses unique to pregnancy. Can Fam Physician. 2013;59(12):1290–1294.
4. Chi CC, Wang SH, Charles-Holmes R, et al. Pemphigoid gestationis: early onset and blister formation are associated with adverse pregnancy outcomes. Br J Dermatol. 2009;160(6):1222–1228.
5. Huilaja L, Mäkikallio K, Tasanen K. Gestational pemphigoid. Orphanet J Rare Dis. 2014;9:136.
This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.
A collection of Photo Quiz published in AFP is available at http://www.aafp.org/afp/photoquiz.
Previously published Photo Quizzes are now featured in a mobile app. Get more information at http://www.aafp.org/afp/apps.
The editors of AFP welcome submissions for Photo Quiz. Guidelines for preparing and submitting a Photo Quiz manuscript can be found in the Authors' Guide at http://www.aafp.org/afp/photoquizinfo. To be considered for publication, submissions must meet these guidelines. E-mail submissions to firstname.lastname@example.org.
Copyright © 2017 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact email@example.com for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions