Gebelik ve Cilt Hastalıkları
Özet
Gebelik döneminde karşılaşılan dermatolojik hastalıklar, gebeliğe özgü olanlar ve olmayanlar şeklinde iki ana grupta incelenmektedir. Gebelikle ilişkili spesifik hastalıklar arasında Pemfigoid Gestasyones, atopik erüpsiyonlar, intrahepatik kolestaz ve prüritik ürtikeryal plaklar yer alır. Pemfigoid Gestasyones, derinin bazal membranındaki kollajen XVII'yi hedef alan maternal IgG antikorları nedeniyle gelişerek erken doğum riskini tetikleyebilir ve tedavisinde güçlü topikal kortikosteroidler ile oral prednizon kullanılır. Fetüs için risk taşımayan atopik erüpsiyonlar içinde en sık egzema görülürken, intrahepatik kolestaz yüksek serum safra asitleri ile karakterizedir. Karın ve bacak bölgesinde izlenen prüritik ürtikeryal plak ve papüller ise doğum sonrasında skarsız şekilde hızla iyileşme gösterir. Gebeliğe özgü olmayan grupta yer alan Akne Vulgaris gebelikten etkilenmezken, Nörofibromatosis preeklampsi ve erken doğum riskini artırır; Hidradenitis Suppurativa ise gebelikte iyileşme eğilimindedir. Kronik bir antite olan Psoriasisin genel seyri olumsuz etki yapmasa da ağır seyreden püstüler psoriasis olgularında sıvı kaybı, sepsis ve plasental yetmezlik gibi ciddi tablolara karşı oral prednison tedavisi uygulanmaktadır.
Dermatological diseases encountered during pregnancy are examined in two main groups as pregnancy-specific and non-specific conditions. Specific pregnancy-related diseases include Pemphigoid Gestationis, atopic eruptions, intrahepatic cholestasis, and pruritic urticarial plaques. Pemphigoid Gestationis develops due to maternal IgG antibodies targeting collagen XVII in the basement membrane of the skin, potentially triggering preterm birth risk, and is treated with potent topical corticosteroids and oral prednisone. While atopic eczema is the most common among atopic eruptions that carry no fetal risk, intrahepatic cholestasis is characterized by high serum bile acids. Pruritic urticarial papules and plaques observed in the abdomen and leg areas resolve rapidly without scarring after delivery. Among non-pregnancy-specific conditions, Acne Vulgaris is unaffected by pregnancy, whereas Neurofibromatosis increases the risk of preeclampsia and preterm birth, and Hidradenitis Suppurativa tends to improve during gestation. Although the general course of chronic Psoriasis does not cause adverse effects, severe cases of pustular psoriasis are treated with oral prednisone against serious conditions such as fluid loss, sepsis, and placental insufficiency.
Referanslar
García Souto F, Cases Mérida S, Escudero Ordoñez J. Pemphigoid gestationis. Med Clin (Barc). 2020;154(8):327. doi:10.1016/j.medcli.2019.05.037
Alvarez Martinez D, Ricard-Gauthier D, Carbonne B, et al. Peau et grossesse [Skin and pregnancy]. Rev Med Suisse. 2022;18(775):596-603. doi:10.53738/REVMED.2022.18.775.596
Huilaja L, Mäkikallio K, Tasanen K. Gestational pemphigoid. Orphanet J Rare Dis. 2014;9:136. Published 2014 Sep 2. doi:10.1186/s13023-014-0136-2
Bechtel MA. Pruritus in Pregnancy and Its Management. Dermatol Clin. 2018;36(3):259-265. doi:10.1016/j.det.2018.02.012
Genovese G, Derlino F, Berti E, et al. Treatment of Autoimmune Bullous Diseases During Pregnancy and Lactation: A Review Focusing on Pemphigus and Pemphigoid Gestationis. Front Pharmacol. 2020;11:583354. Published 2020 Oct 2. doi:10.3389/fphar.2020.583354
Soutou B, Aractingi S. Dermatoses de la grossesse [Pregnancy-specific dermatoses]. Rev Med Interne. 2015;36(3):198-202. doi:10.1016/j.revmed.2014.07.011
Abdelhafez MMA, Ahmed KAM, Daud MNBM, et al. Pemphigoid Gestationis and adverse pregnancy outcomes: A literature review. J Gynecol Obstet Hum Reprod. 2022;51(5):102370. doi:10.1016/j.jogoh.2022.102370
Patel PM, Jones VA, Murray TN, et al. A Review Comparing International Guidelines for the Management of Bullous Pemphigoid, Pemphigoid Gestationis, Mucous Membrane Pemphigoid, and Epidermolysis Bullosa Acquisita. Am J Clin Dermatol. 2020;21(4):557-565. doi:10.1007/s40257-020-00513-3
Roth MM, Cristodor P, Kroumpouzos G. Prurigo, pruritic folliculitis, and atopic eruption of pregnancy: Facts and controversies. Clin Dermatol. 2016;34(3):392-400. doi:10.1016/j.clindermatol.2016.02.012
Balakirski G, Novak N. Atopic dermatitis and pregnancy. J Allergy Clin Immunol. 2022;149(4):1185-1194. doi:10.1016/j.jaci.2022.01.010
Smith DD, Rood KM. Intrahepatic Cholestasis of Pregnancy. Clin Obstet Gynecol. 2020;63(1):134-151. doi:10.1097/GRF.0000000000000495
Delorenze LM, Branco LG, Cerqueira LF, et al. Pruritic folliculitis of pregnancy. An Bras Dermatol. 2016;91(5 suppl 1):66-68. doi:10.1590/abd1806-4841.20164735
Ishikawa-Nishimura M, Kondo M, Matsushima Y, et al. A Case of Pruritic Urticarial Papules and Plaques of Pregnancy: Pathophysiology and Serum Cytokine Profile. Case Rep Dermatol. 2021;13(1):18-22. Published 2021 Jan 25. doi:10.1159/000511494
Mehedintu C, Isopescu F, Ionescu OM, et al. Diagnostic Pitfall in Atypical Febrile Presentation in a Patient with a Pregnancy-Specific Dermatosis-Case Report and Literature Review. Medicina (Kaunas). 2022;58(7):847. Published 2022 Jun 25. doi:10.3390/medicina58070847
Rosales Estrada G, Smith Alpizar R, Braham Velasco J. Eritema nodoso y embarazo. Informe de un caso [Erythema nodosum and pregnancy. Report of a case]. Ginecol Obstet Mex. 1991;59:181-183.
Acar S, Nieblas-Bedolla E, Armstrong AE, et al. A Systematic Review of Recent and Ongoing Clinical Trials in Patients With the Neurofibromatoses. Pediatr Neurol. 2022;134:1-6. doi:10.1016/j.pediatrneurol.2022.06.003
Mohsin N, Hernandez LE, Martin MR, et al. Acne treatment review and future perspectives [published online ahead of print, 2022 Jul 16]. Dermatol Ther. 2022;e15719. doi:10.1111/dth.15719
Ashok Kumar D, Thajudeen H, Agarwal A. A rare case of symptomatic ocular pyogenic granuloma in pregnancy. Indian J Ophthalmol. 2020;68(8):1645-1646. doi:10.4103/ijo.IJO_2239_19
Mohd Yusof J, Abd Halim A, Wan Hamizan AK. Severe epistaxis in pregnancy due to nasal pyogenic granuloma: A case report. J Taibah Univ Med Sci. 2020;15(4):334-337. Published 2020 Jul 20. doi:10.1016/j.jtumed.2020.06.007
Tauscher AE, Fleischer AB Jr, Phelps KC, et al. Psoriasis and pregnancy. J Cutan Med Surg. 2002;6(6):561-570. doi:10.1007/s10227-001-0147-1
Balakirski G, Gerdes S, Beissert S, et al. Therapy of psoriasis during pregnancy and breast-feeding. J Dtsch Dermatol Ges. 2022;20(5):653-683. doi:10.1111/ddg.14789
Flood KS, Savage KT, Porter ML, et al. Treatment of psoriasis in pregnancy. Cutis. 2020;106(2S):15-20. doi:10.12788/cutis.0031
Trivedi MK, Vaughn AR, Murase JE. Pustular psoriasis of pregnancy: current perspectives. Int J Womens Health. 2018;10:109-115. Published 2018 Feb 26. doi:10.2147/IJWH.S125784
Beksac B, Adisen E, Gurer MA. Treatment of Generalized Pustular Psoriasis of Pregnancy With Infliximab. Cutis. 2021;107(3):E2-E5. doi:10.12788/cutis.0210
