Appendage abnormalities: Acne and Hair Changes
Appendage abnormalities: Acne and Hair Changes (C. Ambros Rodolph).
During Pregnancy some skin conditions are more frequent:
- Specific Dermatosis: The 2 most frequent are:
- atopic eruption of pregnancy( 41%)
- polymorphic urticarial papules and plaques of pregnancy (PURPP)
- Non specific dermatoses account for 40% of causes: of these one third of each are inflammatory and infectious in nature
- changes during pregnancy:
- increased eccrine function: miliara for example
- decreased aprocrine function: hidradentis suppurativa (acne inversa, Verneuil’s Disease) improves
- increased sebaceous function
Acne Vulgaris
causes:
- in general
- androgen induced sebum production
- altered keratinization
- bacterial colonization and inflammation
- specific to pregnancy:
- LH/FSH increase
- vascular changes
- Immune alterations which activate inflammation through toll like receptors.
existing acne shows improvement in late pregnancy
new onset acne presents in early pregnancy
acne gravidarum
- Characteristics
- seborrhea
- comedones as a primary change. papules and pustules also possible.
- localisation on lower part of face
- affects other areas then the face: back and torso
Safe Treatments during pregnancy :
- topicals:
- antiseptics
- benzoyle peroxide (BP)
- azelaic acid
- erythromycin (combined with BP)
- chemical peels with AHA (alpha hydroxy acids)
- systemic:
- erythromycin
- CST (corticosteroids)
- lasers
- IPL (Intense-Pulse Light)
- UVB
Rosacea (Rosacea Fulminans)
- Rosacea Fulminans can occur in Pregnancy:
- Affects women aged 15 to 46
- Etiology is unknown
- Clinically papulopustules are present but tend to spare the perioral area
- Therapy should be corticosteroids and systemic isotretinoin, but the latter is not possible in pregancy
Safe treatments during pregnancy
- topical:
- metronidazole
- erythromycin
- azelaic acid
- permethrin
- CST
- uv protection
- mild washing
- avoiding triggers (spices…)
- systemic:
- erythromycin
- Corticosteroids (CST)
- lasers
- IPL (Intense-Pulsed Light)
- Rosacea Fulminans during pregnancy treatment: An example
- erythromycin 500 mg bd
- prednisone 50mg in diminishing doses over 2 weeks
- sunscreen SPF 50
- permethrin and zinc cream
If breastfeeding: allow a pause of 4 hours between CST and breatfeeding
A word about CST usage during pregnancy:
- 1st trimester: use a maximum of 10-15mg a day as there is a risk for cleft palate
- 2nd and 3rd Trimester: risk of abnormal maturation and growth retardation
Hair changes
- Hirsutism
- Telogen Effluvium occurs because of synchronization at delivery of anagen phase. Hair loss can sometimes be frontal and or temporal. Resolution happens within 1-5 months but may take up to 15 months
Note: Minoxidil is contraindicated during pregnancy and lactation
Source of Information: WS02. Physiological Changes In Pregnancy: A Frequent Event. 2011 (10) – 20th Annual Congress of the EADV (European Academy of Dermatology and Venerology) – Lisbon (Lisboa), Portugal
