Feature Article

Itchy rashes in pregnancy: an approach to diagnosis and management

Anne Halbert
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Itch is a common symptom in pregnancy, affecting at least 17% of gravid women. Although many cases are due to common skin conditions coincidental to the pregnancy, the specific pregnancy-related dermatoses should always be considered.

Key Points

  • Atopic eruptions, including dermatitis, folliculitis and prurigo, are the most common itchy rashes in pregnancy.
  • Polymorphic eruption of pregnancy is most common in primigravidas, women pregnant with twins, and women who gain excessive weight during pregnancy.
  • Polymorphic eruption of pregnancy starts on the abdomen, in or near stretch marks.
  • Intrahepatic cholestasis of pregnancy is strongly associated with an adverse fetal outcome.
  • The hallmark of pemphigoid gestationis is a band of the complement component C3 along the dermoepidermal junction.
  • Pemphigoid gestationis, intrahepatic cholestasis and generalised pustular psoriasis of pregnancy can all recur with subsequent pregnancies and with use of the oral contraceptive pill.