What Is a Pregnancy Rash?

During pregnancy, especially in the first trimester, pregnant women may experience systemic or localized skin itching, ranging in severity from severe to severe, which can be restless and unbearable. This condition is called pruritus of pregnancy. The pruritus of pregnancy can be manifested as paroxysmal and persistent. It is often during the day when you are nervous during work, or when you are mentally concerned about other things. Itching is mild or not itching. When it is late at night, itching is often severe. And the heavier it gets, the harder it is to fall asleep. Some pregnant women with itchy pregnancy have miliform rash on their skin, some don't have rash, some will quit on their own in a short period of time, and some will continue until the termination of pregnancy. The itch will soon disappear after delivery. Because this kind of skin pruritus is a characteristic symptom during pregnancy, it is also called pregnancy pruritus or pruritus pregnancy.

Basic Information

Also known as

Pruritus of pregnancy

English name

prurigogestationis

Visiting department

dermatology

Common locations

dermatology

Common symptoms

Itching

Causes of prurigo during pregnancy

One of the causes of itching in pregnancy may be related to the high estrogen content in the blood of the pregnant woman, and the second is related to cholestasis. Researchers believe that as the gallbladder emptying time of pregnant women is prolonged, the gallbladder is dilated and the tension is reduced, which leads to the formation of cholestasis, and the content of bile acids and bile salts is increased, which causes itching of the skin.

Clinical manifestations of prurigo during pregnancy

First trimesters usually do not suffer from pruritus during pregnancy. Clinically, it is often divided into the following two types according to the period when the rash appears:

1. Early-onset prurigo of pregnancy

It occurs in the first half of pregnancy, especially in the third and fourth months of pregnancy. Pimples occur in the extremities of the extremities, the upper part of the trunk, and the thighs of the upper arms, and are symmetrically distributed on both sides. Round, millet as large as mung beans, slightly flattened at the top. White at first, dark red, light red, or normal complexion later. There are urticaria-like flushes around the pimples. The pimples may resolve over a few days or dozens of days, but new pimples may recur. Itching is severe, especially at night, and the scratches cover the yellow palate on the pimples. After the peeling of the crusts, local pigmentation or pigment loss remains.

2. Delayed pregnancy prurigo

It usually occurs in the last 2 months of pregnancy, especially within 2 weeks before giving birth. The rash has the same form as prurigo rash in early pregnancy, and papules and wind-like rashes can be seen, resembling polymorphous erythema. The rash mostly occurs on the old stretch marks (atrophy marks) on the abdominal wall, and then it can quickly spread to the whole body with severe itching. Due to scratching, secondary rashes such as scratches, hemorrhoids, and lichenification were visible. The disease resolves itself 2 to 3 weeks after delivery, leaving temporary pigmentation.

Pruritus during pregnancy

According to the characteristics of the maternal, rash and period, and the pathological changes of the skin tissue, the diagnosis is more difficult.

Differential diagnosis of prurigo during pregnancy

The disease must be distinguished from pruritic pimples and plaques during pregnancy. The latter features are: more common in the first pregnant women, after 36 weeks of pregnancy onset, severe itching. Skin lesions are more common in swollen lines, small red pimples 1 to 2 mm in size, and soon merge into large red plaques. It is more common in the abdomen. Later, urticaria and papular rashes spread to the hips, thighs, and chest, and the face is rarely affected. The illness of pregnant women does not affect the fetus, and the rash resolves on its own several days after delivery. Because the pathological changes of skin tissue are similar to prurigo of pregnancy, they can only be distinguished by clinical manifestations. Can be diagnosed according to the time of onset, the location of the rash and the characteristics of the damage. However, it should be distinguished from erythema polymorpha, insect bites and herpes pregnancy.

Polymorphic erythema

It is a self-limiting skin disease. The rash is pleomorphic and has a target-shaped or iris-like rash. It can invade the mucosa and is easy to distinguish.

2. Insect bites

It is often a wind-like papules with papules or small blisters in the center of the rash, and a clear history of bites by arthropods or insects.

3. Herpes of pregnancy

It is an autoimmune disease and can occur at any stage of pregnancy. The rash is erythema, pimples or herpes-like dermatitis-like rash, which is mostly distributed in the palms, trunk and limbs, but it does not tend to occur in stretch marks. Direct immunofluorescence examination, taking maternal lesions and surrounding skin, showing that the basement membrane has linear C3 and lgG deposits, can be distinguished from PUPPP (pregnant pruritic urticaria-like pimples).

Itching during pregnancy is a unique symptom during pregnancy. Although it may include certain skin diseases with good prognosis, it must be carefully identified to exclude those caused by the virus that seriously threaten the life and teratogenicity of pregnant women and fetuses (embryos). Skin diseases, such as rubella, pregnancy herpes, herpes-like impetigo, etc. Pregnant women with the above-mentioned skin diseases must terminate their pregnancy, and do not blindly treat the disease and protect the fetus to avoid serious consequences.

Prurigo complication of pregnancy

A severe rash is not good for the fetus and can cause stillbirth.

Prurigo of pregnancy treatment

1. Instruct patients to live as regularly as possible, take frequent showers, keep the skin clean, and avoid eating spicy and irritating food.

2. Glucocorticoids have a good effect on severe prurigo of pregnancy and can reduce the incidence of stillbirth. Pregnant women should take the medicine as short as possible. Prednisone is often used to shorten the course of treatment. Symptoms were significantly reduced and gradually reduced until maintenance was stopped. It is not advisable to apply glucocorticoids after labor.

3. It is possible to apply topical skin rubbing until itching. The drugs selected are glycerin / sodium chloride (composite glycerin) lotion (glycerin, 95% ethanol, distilled water), antipruritic tincture (liquified phenol, mint, salicylic acid, 75 % Ethanol to 100ml), calamine lotion (calamine, zinc oxide, glycerol, calcium hydroxide solution 100ml) and so on.

4. Application of antihistamines, diphenhydramine and chlorpheniramine are often used.