Table 1 Differential diagnostics of pregnancy associated pruritic dermatoses
From: Gestational pemphigoid
| Â | Atopic eruption of pregnancy | Polymorphic eruption of pregnancy | Intrahepatic cholestasis of pregnancy | Gestational pemphigoid |
|---|---|---|---|---|
Estimated incidence | Most common pregnancy associated dermatose. 1:5–1:20 | 1:160 | 1:50–1:5000 | 1:40000–1:50000 |
High-risk groups | Â | Primigravidity | Â | Multiparity |
Obesity | ||||
Multiple pregnancy | ||||
Skin manifestations | Pruritus | Pruritus | (Nocturnal) pruritus | Pruritus |
Eczematous lesions | Urticarial papules and plaques | Secondary skin lesions due to scratcing | Papules | |
Urticarial plaques | ||||
Target lesions | ||||
Blisters, vesicles | ||||
Papules | Sparing of the umbilical region | Jaundice | Â | |
Localization of skin manifestations | Trunk | Lower abdomen | Extremities (palms and soles) | Abdomen, umbilicus |
Extremities | ||||
Extensors of the extremities | Striae | Â | Â | |
Thighs | ||||
Body | ||||
Studies | S-IgE levels may be elevated | Negative DIF | Elevated total serum bile acid levels | Linear C3 (and IgG) positivity in DIF. BP180 ELISA |
Symptom onset (trimester of pregnancy) | I-II | III | III | II-III |
Parturition/Lactation | Symptom resolution | Symptom resolution | Symptom resolution | Flare-up in connection to delivery |
Pregnancy complications | No fetal risks | No fetal risks | Stillbirth | Prematurity |
| Â | Â | Â | Fetal growth restriction | |
Newborn | No harm to newborn | No harm to newborn | No harm to newborn | Possibility for transient skin blistering |
Recurrence | No elevated risk for recurrence | No elevated risk for recurrence | Elevated risk for recurrence | Recurrence is usual. |
Activation of symptoms is possible during menstruation and hormonal contraceptive use |