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1、 妊娠皮膚病簡介生理的變化 w 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-Hyperpigmentationw90% : skin darkening ; MSH and estrogen w Beginning early in pregnancy and more pronounced in naturally hyperpigm
2、ented areas such as areolare , perineum and umbilicus and axillae and inner thigns, Linea nigra wFace: cholasma or melasma ; 50% , sunscreens ; Regress postpartum , dermal melanosis persist up to 10 years in 1/3 pts w2-5% hydroxquinone , 0.1% tretinoin gel or cream or 20% azelaic acid cream cholasma
3、 or melasma黑斑 or 肝斑Linea nigra 常見的變化-NaviwPigmented cutaneous tumors commonly enlarge and darken during pregnancy , leading to their confusion with malignant melanomas. w6% changed in diameter over pregnancy wNo evidence that they undergo malignant transformations常見的變化-Hair GrowthwGrowing hair phase
4、 is increased related to the resting hair phase wEstrogen prolong the growing hair phase and androgens cause enlargement of follicles wTelogen effluvium: abrupt hair loss beginning 1 to 4 months postpartum ; self limited and restored in 6 to 12 months 常見的變化-Vascular changewAugmented cutaenous blood
5、flow: estrogen and decreased vascular resistance wSpider angiomas : 2/3 white and 1/10 black wPalmar erythema : 2/3 white and 1/3 black wPapillary hemangiomas: 5% wPregnancy gingivitis (epulis): growth of the gum capillaries wPyogenic granuloma of pregnancy (granuloma gravidarum) : oral cavity and a
6、rise from the gingival papillae Spider angiomas Palmar erythema Pregnancy gingivitis (epulis)Pyogenic granuloma of pregnancy 妊娠紋w8090 的孕婦 w懷孕67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 。 w除了荷爾蒙的影響，體重增加太快也是促成原因之一 。 w雖然在產後會慢慢變白、變細，但很多人是無法完全恢復的 w控制體重 w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 ，
7、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。Dermatoses of pregnancy w1.6 % of women had significant pruritus at some time during prengancy wPruritus gravidarum wPrurutuc ureticarial papules and plaques of pregnancy wHerpes gestationis Pruritus Gravidarum w0.6% pregnancy with pruritus : mild variant of intrahepati
8、c cholestasis of pregnancy w Scratching and excoriation skin lesions wHormone,genetics and enviornmental factors Pruritic urticarial papules and plaques of pregnancy w PUPPP in US ; Polymorphic eruption of pregnancy (PEP) in UK w 1/200 singleton , 8/200 for twin w Pruritic cutaneous eruption that us
9、ually appears late in pregnancy ; abdomen firstly and then buttocks and thighs and extremities. w40%: urticarial ; 45% erythematous pattern ; 15% combination; face spared and common in nulliparas and seldom recurs in subsequent pregnancy . wResemble herpes gestationis but no veiscles or bullae Pruri
10、go of pregnancy wPapular eruptions of pregnancy wPrurigo gestationis and papular dermatitis wPrurigo gestationis : small pruritic , rapidly excoriated lesions on the forearms and trunk wNo vesicles or bullae wOnset at 25 to 30 weeks and may persist for 3 months after delivery wRecurrence is common w
11、Oral antihistamines and topical corticosteriod creams wPerinatal outcome : not affected Herpes gestationis (1)wNoninfectious disorder wAutoimmue pruritic blistering skin eruption affects multiparous women in late pregnancy and may begin early in pregnancy or within a week or postpartum wPemphioid ge
12、stationis : immunologically similar to bullous pemphgoid w1/5000 pregnancies wExtremely pruritic widespread eruption with lesions that vary from erythematous and edematous papules to large , tense vesicles and bullae. Herpes gestationis (2)wTopical corticosterioids and oral antihistamines w Orally p
13、regnisone 0.5 to 1 mg/kg daily , brings relief and inhibits formation of new lesions wThe healed sites are not scarred but frequently are hyperpigmented wRefractory cases: immunosuppresives , such as cyclophosphamide , methotrexazte and cyclosporine. wBullous pemphigoid : plasmapheresis and high dos
14、e IG therapy Herpes gestationis (3)wReports of association with preterm birth , stillbirths and growth restriction wIncreased surveillance is recommended wLesions similar to those of the mother develop in up to 10% of neonates Preexisting skin disease wAcne: Isotretinoin , etretinate and tretinoin a
15、re strictly contradicted in pregnancy teratogenic wPregnancy : topically applied benzoyl peroxide and clindamycin or erythromycin gel wTopical tretinoin is thought to pose no significant teratogenic riskPreexisting skin disease(2)wPsoriasis improves in up to 50% during pregnancy and 20 % worse wLoca
16、lized : Topical corticosteroids calciportriene , antrhalin and tacrolimus w Generalized mild disease: UV-B phtotherapy or plus psoralens and oral cyclosporing if unsuccessful w Moderate and severe: plus topical or oral corticosteriods wCoal tar derviatives as well as oral and systemic immunosupressives ( MTX, cyclosporine , tacrolimus) are avoidedThank you for your attention
