Rashes or itchy skin during pregnancy can carry risks for you and your baby. Find out if you are at risk and the treatment options available, from the Women's Dermatology Service at KK Women's and Children's Hospital (KKH).
Dr Mark Koh, Head and Consultant,
Dermatology Service,
KK Women’s & Children’s Hospital (KKH), a member of the
SingHealth group, discusses three types of pregnancy-related skin conditions.
Atopic eruption of pregnancy
Atopic eruption of pregnancy (AEP) is a term now used to encompass conditions including eczema in pregnancy, prurigo of pregnancy and pruritic folliculitis of pregnancy.
AEP is not associated with any adverse outcomes for the unborn baby.
What does atopic eruption of pregnancy look like?
Patients with atopic eruption of pregnancy have itchy, scaly, reddish (erythematous) rashes, most commonly on the limbs and trunk. In some cases, the intense itch and scratching can lead to the formation of thickened areas of skin.
Who’s most at risk of developing atopic eruption of pregnancy?
Patients commonly have a personal or family history of other allergic conditions, e.g. atopic dermatitis, allergic rhinitis (hay fever) or asthma. AEP has been estimated to occur in up to 5 per cent of pregnant patients. AEP tends to occur earlier in pregnancy compared to PEP, with many patients presenting in the 1st and 2nd trimesters.
How is atopic eruption of pregnancy treated?
Treatment of AEP includes the use of topical moisturisers, topical corticosteroids and oral antihistamines. In severe cases, a course of oral steroids may be prescribed. Although the condition usually improves or disappears after delivery, some patients may develop chronic eczema.
Intrahepatic cholestasis of pregnancy
Intrahepatic cholestasis of pregnancy is uncommon. The condition is thought to be due to a combination of genetic factors, environmental influences and the hormonal changes that occur in pregnancy.
Most patients with intrahepatic cholestasis of pregnancy have abnormal results on tests of liver function, especially high bilirubin levels. This condition is strongly associated with fetal complications including preterm delivery and fetal distress. Miscarriages have been reported.
What does intrahepatic cholestasis of pregnancy look like?
Patients present with severe itching, usually in the 3rd trimester of pregnancy. The itching is usually worse at nights. The only visible skin lesions are the multiple scratch marks inflicted by the patient herself.
Who’s most at risk of developing intrahepatic cholestasis of pregnancy?
A familial predisposition has been shown. The condition tends to reappear during subsequent pregnancies.
How is intrahepatic cholestasis of pregnancy treated?
The treatment of intrahepatic cholestasis of pregnancy aims to reduce the level of bile acids in the mother-to-be. Treatment has been shown to decrease the risk of fetal complications.
Some doctors will recommend inducing labour at 37 weeks, especially if the blood work remains abnormal despite therapy. Both the itching and the abnormal blood results go away on their own after delivery.
See previous page for a more common pregnancy skin condition - polymorphic eruption of pregnancy (PEP).
Ref: Q15
