154 Obstetrics and Gynecology Board Review •••
DERMATOLOGY
❍ What are some changes that occur in the skin during pregnancy?
Hyperpigmentation of the skin, striae gravidarum, and increased hair growth.
❍ What is the most common pruritic pregnancy-specific dermatosis?
Pruritic urticarial papules and plaques of pregnancy (PUPPP). It is also called polymorphic eruption of pregnancy (PEP).
❍ Where do the lesions of PUPPP usually develop first?
On the abdomen, usually around striae. The lesions may then spread to the buttocks, thighs, and extremities.
❍ How is PUPPP treated?
Oral antihistamines, skin emollients, and topical corticosteroids. 10% may require systemic steroids.
❍ What are risk factors for developing PUPPP?
Caucasian race, nulliparity, multifetal gestation, and is more common with a male fetus.
❍ What is herpes gestationis?
It is a rare, noninfectious, autoimmune blistering skin condition that occurs in 1:10,000 to 50,000 pregnancies. It
occurs more commonly in women with HLA-DR3 and HLA-DR4 antigens and is characterized by IgG antibodies
against the epidermal basement membrane.
❍ How is herpes gestationis treated?
Topical corticosteroids and oral antihistamines are first line, but most women require systemic steroids and
occasionally cyclosporine or intravenous immunoglobulin (IVIG).
❍ What is the effect of pregnancy on psoriasis?
Psoriasis improves in 40% of women, is unchanged in 40% and worsens in 20%.
❍ What medications for psoriasis are safe in pregnancy?
Topical corticosteroids, calcipotriene, anthraline, or tacrolimus, ultraviolet B (UVB) phototherapy, and oral
cyclosporine. Methotrexate and mycophenolate mofetil should not be used in pregnancy.
❍ How is acne treated in pregnancy?
Oral retinoic acid derivatives are strictly contraindicated in pregnancy because they are highly teratogenic. Topical
tretinoin cream is poorly absorbed and is considered to pose little teratogenic risk. Topical benzoyl peroxide is safe
in pregnancy.
NEUROLOGIC
❍ How does pregnancy affect migraine headaches?
50% to 70% of women report improvement in migraine headaches during pregnancy, although occasionally
migraine headaches may arise for the first time during pregnancy.