Pemphigoid gestationis, cholestasis: dermatoses of pregnancy may recur with OC use.(Obstetrics)

WASHINGTON -- Women who had either pemphigoid gestationis or cholestasis of pregnancy should be counseled that later oral contraceptive use may trigger a flare-up of dermatoses, Dr. Thelda M. Kestenbaum said at the annual meeting of the American Academy of Dermatology.

Itchy rashes, blisters, and other symptoms associated with these two dermatoses of pregnancy also may recur when menstruation resumes, or in subsequent pregnancies, she added.

Dermatoses of pregnancy "has been a particularly murky and confusing area" for a number of reasons, observed Dr. Kestenbaum of the University of Kansas, Kansas City. "Many diseases that were thought to be exclusive for pregnancy were not particularly," she said, citing atopic eczema/dermatitis as an example. "When it appears in a pregnant woman, it doesn't need to be called a special name," she added.

A second reason is that many names were given to the same disorder--"a primary example is PUPPP [pruritic urticarial papules and plaques of pregnancy]," Dr. Kestenbaum said. PUPPP has probably been called polymorphic eruption of pregnancy, toxic erythema, late onset prurigo, and toxemic rash of pregnancy.

An estimated 1 in 160 pregnant women will develop PUPPP, usually during the first pregnancy. The symptoms begin with itching in stretch marks, followed by erythematous papules and plaques and stretch marks that spread to the breasts, thighs and arms. Women with PUPPP also may have vesicles (up to 40%) and erythema multiforme-like lesions (up to 20%). PUPPP tends to spare the face, palms, soles, and mucous membranes. Symptoms typically begin at 36-39 weeks' gestation, but also can occur postpartum. Dr. Kestenbaum cited one study that suggests fetal cells in maternal circulation may play a role in PUPPP (Lancet 351[9102]:559-62, 1998).

According to Dr. Kestenbaum, pemphigoid gestationis (formerly called herpes gestationis) and cholestasis of pregnancy (also called interhepatic cholestasis of pregnancy) are the two dermatoses of pregnancy that are associated with increased risks and thus deserve a special classification.

Pemphigoid gestationis is considered a rare disorder, with an incidence rate of 1 in 50,000 pregnant women. The onset is typically in the second trimester, usually at 21 weeks' gestation; but it also may occur from 9 weeks' gestation to 1 week postpartum. In subsequent pregnancies, pemphigoid gestationis tends to occur earlier and more severely, Dr. Kestenbaum said.