Gebelikte Cilt Hastalıkları
Özet
Gebelik, kadın vücudunda fizyolojik, hormonal ve metabolik değişikliklere yol açarak cilt ve cilt eklerinde belirgin farklılıklar meydana getirir. Bu süreçte en sık gözlenen fizyolojik değişimler arasında areola, genital bölge ve linea nigrada beliren hiperpigmentasyon, yüzde oluşan melasma, östrojen artışına bağlı spider anjioma gibi vasküler değişiklikler, karın ve memede oluşan strialar ile doğum sonrası saç dökülmesi (telogen effluvium) yer alır. Fizyolojik dönüşümlerin yanı sıra gebeliğe özgü inflamatuar ve kaşıntılı dermatozlar da gelişebilir. Bunlar; nadir ve otoimmün büllöz bir hastalık olan pemfigoid gestasyonis, sıklıkla strialardan başlayan ve primiparlarda görülen gebeliğin polimorfik erüpsiyonu (PEP/PUPPP), en sık rastlanan dermatoz olan gebeliğin atopik erüpsiyonu, primer cilt lezyonu olmaksızın şiddetli kaşıntıyla seyreden gebelik kolestazı ve nadir bir varyant olan gebeliğin püstüler psöriazisidir. Bu hastalıklardan pemfigoid gestasyonis, gebelik kolestazı ve püstüler psöriazis; prematürite, düşük doğum ağırlığı ve fetal kayıp gibi ciddi fetal risklerle ilişkilidir. Tanı süreçlerinde detaylı klinik öykü ve fizik muayenenin yanı sıra, şüpheli durumlarda histopatolojik değerlendirme ve direkt immünfloresan inceleme için cilt biyopsisi ile laboratuvar testleri uygulanır. Tedavide semptomların kontrolü öncelikli olup, genellikle ilk basamakta topikal kortikosteroidler ve kaşıntı için antihistaminikler tercih edilirken, dirençli veya şiddetli vakalarda sistemik steroidler ya da alternatif immünsupresif ajanlar kullanılır.
Pregnancy leads to physiological, hormonal, and metabolic changes in the female body, causing significant differences in the skin and its appendages. The most common physiological changes observed during this period include hyperpigmentation appearing on the areola, genital area, and linea nigra, melasma on the face, vascular changes such as spider angioma secondary to increased estrogen, striae formed on the abdomen and breasts, and postpartum hair loss known as telogen effluvium. In addition to physiological transformations, pregnancy-specific inflammatory and pruritic dermatoses can also develop. These include pemphigoid gestationis, a rare and autoimmune bullous disease; polymorphic eruption of pregnancy (PEP/PUPPP), which frequently originates in striae and is seen in primiparous women; atopic eruption of pregnancy, which is the most common dermatosis; intrahepatic cholestasis of pregnancy, characterized by severe generalized pruritus without primary skin lesions; and pustular psoriasis of pregnancy, which is a very rare variant. Among these conditions, pemphigoid gestationis, cholestasis of pregnancy, and pustular psoriasis are associated with serious fetal risks such as prematurity, low birth weight, and fetal loss. In diagnostic processes, along with a detailed clinical history and physical examination, skin biopsy for histopathological evaluation and direct immunofluorescence testing, as well as laboratory tests, are utilized in suspicious cases. Management primarily focuses on symptom control, where topical corticosteroids and antihistamines for pruritus are generally preferred as the first line, while systemic steroids or alternative immunosuppressive agents are employed in resistant or severe cases.
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