Matthew Bremmer, MD Dr. Bremmer is a former resident in the Department of Dermatology, University of Maryland School of Medicine, Baltimore, Md.
Marcia S. Driscoll, MD, PharmD Dr. Driscoll is Clinical Associate Professor in the Department of Dermatology, University of Maryland School of Medicine, Baltimore, Md.
Richard Colgan, MD Dr. Colgan is Associate Professor in the Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, Md.
The authors reported no financial relationships relevant to this article.
The papules and pustules of PFP are concentrated around hair follicles.
Pathophysiology. Like many other dermatoses of pregnancy, the pathophysiology of PFP is unknown. There is little evidence that the condition is immunologically or hormonally mediated, and there is no evidence of an infectious component.24,28
Differential diagnosis. PFP must be distinguished from infectious folliculitis, acneiform disorders, HIV-associated eosinophilic folliculitis, and a drug reaction.
Diagnosis. The clinical diagnosis is based on presenting symptoms and third-trimester onset. No specific laboratory or histologic analysis can be used to make a definitive diagnosis.
Treatment. As the condition is, by definition, a nonmicrobial folliculitis, the most effective therapy tends to be with a low- or midpotency topical corticosteroid, such as triamcinolone or desonide. A benzoyl peroxide wash can also be effective.
Sequelae. One study reports an increased incidence of low birth weight, but no associated morbidity or mortality has been reported in recent studies.24
Key recommendations for your practice
Pemphigoid gestationis is best managed with oral prednisone at doses from 20 to 60 mg per day to control symptoms
The pruritus associated with pruritic urticarial papules and plaques of pregnancy can be safely and effectively managed with topical corticosteroids and oral antihistamines
Treat intrahepatic cholestasis of pregnancy with ursodeoxycholic acid, which likely reduces serum bile acids as well as associated fetal morbidity and mortality
