A prospective study of 200 women with dermatoses of pregnancy correlating clinical findings with hormonal and immunopathological profiles

In 1994 we set up a specialist clinic for pregnancy dermatoses, both to imp rove the management of pregnant women with skin problems and to enhance our general understanding of the pregnancy dermatoses. This clinic has provide d a large database of 200 women which has formed the basis for a prospectiv e study over a 2-year period. In each case the dermatological diagnosis was clearly defined on clinical criteria, with additional help from histopatho logy and direct immunofluorescence of the skin where appropriate. We have i ncluded a number of patients who presented with relatively trivial diagnose s, as this reflects the referral patterns of our midwives, general practiti oners and obstetricians within our hospital and local population. Our resul ts show that all patients with specific dermatoses of pregnancy conformed w ell to the classification established by Holmes and Black in 1983. The role of the sex hormones [oestradiol, human chorionic gonadotrophin (hCG) and c ortisol] in polymorphic eruption (PEP) and prurigo of pregnancy was studied in 125 cases and compared with 138 normal healthy pregnant controls. For p ruritic folliculitis (PF), serum androgens were measured to establish if th ese were elevated. Nearly all patients were followed up postpartum, with re spect to both maternal and fetal prognosis (some were unfortunately lost to follow-up). Many patients were primiparous (47%) and presented in their th ird trimester (49%). This study shows a surprisingly high prevalence of eczema during pregnancy. It is possible that earlier cases in the literature termed prurigo of preg nancy may in fact have been eczema, thus explaining the low incidence of pr urigo in this study. Hormonal analysis showed a significant reduction in se rum cortisol levels in patients with PEP compared with normal pregnant cont rols (P = 0.03), although hCG and oestradiol showed no differences. Serum a ndrogens were not significantly elevated in patients with PF compared with controls. Birthweight (analysed by the individualized birthweight ratio) wa s significantly reduced in both the PE and pemphigoid,gestationis groups. I n the PEP and PF groups there was a male/female infant ratio of 2 : 1, not noted in previous studies. In all cases studied there were no adverse effec ts either on maternal or fetal outcome as a result of the pregnancy dermato sis. This study indicates that all patients fufilled the criteria of the pr evious classification of the specific dermatoses of pregnancy, although we also now highlight the frequency of eczema in pregnancy and speculate as to possible causes. There were no cases of papular dermatitis of pregnancy. W e feel that the specialist clinic is an important service which has improve d the management of these women and identified areas for further research.