What you need to know: Atopic Eruption of Pregnancy (AEP)

SKIN by Leoni Agnes

Skin Changes Associated with Pregnancy

  • Pregnancy is characterized by altered endocrine, metabolic, and immunologic milieus.
  • These alterations result in multiple cutaneous changes, both physiologic and pathologic.
  • The most common physiologic changes are darkening of linea alba (linea nigra), melasma, and striae distensae.
  • Linea nigra:
    • A hyperpigmented line extends from the pubis symphysis to the xiphoid process of the sternum.
    • Hyperpigmentation is often more pronounced inferior to the umbilicus.
  • Melasma:
    • Blotchy, mottled hyperpigmentation is evident on the malar cheek and upper cutaneous lip.
  • Striae distensae:
    • Also known as striae gravidarum.
    • Sites of predilection for striae are those areas most prone to stretch (abdomen, hips, buttocks, breasts).

Skin Diseases in Pregnancy

  • Pruritus occurring in pregnancy may result from a flare of preexisting dermatosis or a pregnancy-specific dermatoses.
  • Pregnancy-specific dermatoses associated with fetal risk:
    • Cholestasis in pregnancy
    • Pustular psoriasis of pregnancy (impetigo herpetiformis)
    • Pemphigoid gestationis
  • Pregnancy-specific dermatoses not associated with fetal risk:
    • Polymorphic eruption of pregnancy
    • Prurigo gestationis
  • AEP is the most common pregnancy specific dermatoses followed by Polymorphic Eruption of Pregnancy (PEP).

What is Atopic Eruption of Pregnancy?

  • Atopic eruption of pregnancy (AEP) is a benign, self-limited pruritic disorder of pregnancy, seen in patients with a personal and/or family history of atopy, and clinically presents as E-type (eczematous lesions) and P-type (popular lesions).
  • AEP comprises approximately 50% of all pregnancy dermatoses. 75% before 3rd trimester.
  • Tends to recur in subsequent pregnancies due to the atopic background.

Etiology & Pathogenesis

Altered pattern of Th:

  • ↑ Production of Th-1 cytokines (IL-2, interferon gamma, IL-12)
  • ↓ Th-2 cytokines (IL-4 & IL-10 production)

Clinical Presentation

Eczematous eruption (E-type AEP):

  • Widespread eczematous changes
  • Predilection: face, neck, the flexor surfaces or the extremities

Papular lesions (P-type AEP):

  • Discrete, pruritic, excoriated papules
  • Predilection: extensor surface, with truncal involvement less common

Diagnostic Tests

  • Histopathology is non-specific
  • Direct and indirect immunofluorescence are negative
  • Laboratory tests may reveal elevated serum IgE levels in 20-70%

Treatment

  • Treatment seeks to ameliorate pruritus and includes emollients, midpotency topical corticosteroids, and antihistamines.
  • Benzoyl peroxide may be helpful for truncal & follicular lesions
  • Phototherapy (UVB) is a safe additional tool, particularly for severe cases in early pregnancy.

Prognosis

  • Maternal prognosis is good even in severe cases as skin lesions usually respond quickly to therapy.
  • Recurrence in subsequent pregnancies is common.
  • Fetal prognosis is unaffected, but there might be a risk of developing atopic skin changes in the infant, later-on.

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