Поліморфний дерматоз вагітних

Lesions are intensely itchy, erythematous, solid, superficial, and elevated; some are surrounded by blanching, and some have minute vesicles in the center. Itching keeps most patients awake, but excoriation is uncommon. Lesions begin on the abdomen, frequently on striae atrophicae (stretch marks), and spread to the thighs, buttocks, and occasionally the arms. The palms, soles, and face are usually spared. Most patients have hundreds of lesions.

Lesions develop during the third trimester, most often in the last 2 to 3 weeks and occasionally in the last few days or postpartum. They usually resolve within 15 days after delivery but can take longer. They may recur in up to 5% of subsequent pregnancies.

• Skin examination

Polymorphic eruption of pregnancy is diagnosed by examining the skin. Differentiation from other pruritic eruptions may be difficult. Early lesions of polymorphic eruption of pregnancy usually start in striae on the abdomen; in pemphigoid gestationis, early lesions are usually periumbilical.

• Corticosteroids

• Nonsedating oral antihistamines

• Supportive care

Mild symptoms are treated with topical corticosteroids (eg, 0.1% triamcinolone acetonide cream up to 2 or 3 times a day). Rarely, more severe symptoms require systemic corticosteroids (eg, prednisone 40 mg orally once a day, tapered as tolerated). Short courses of systemic corticosteroids given late in pregnancy do not seem to have adverse effects on the fetus.

Nonsedating oral antihistamines can also be used to relieve pruritus.