These lesions are typiied by benign cutaneous neuroibromas, cafe-au-lait spots, axillary and inguinal freckling, benign nodules of the iris (Lisch nodules), and optic nerve gliomas. Neuroibromas may increase in size and number during pregnancy (Cesaretti, 2013; Dugof, 1996). With the more common neuroibromatosis type 1, higher rates of preclampsia and preterm birth complicate pregnancy (Leppavirta, 2017; Terry, 2013). With neurofibromatosis type 2, some evidence suggests a risk for preeclampsia (Terry, 2015). Prenatal genetic diagnosis is available for both types (Merker, 2015; Spits, 2007).
Rosacea ulminans is also known as pyoderma aciale. It is rare and characterized by facial pustules and coalescing draining sinuses. Topical or oral antimicrobials are primary treatment, although surgical drainage and corticosteroids have also been used (F uentelsaz, 2011; Jarrett, 2010).
Hidradenitis suppurativa is said to improve with pregnancy, but in our experiences, it is not appreciably changed. Twice daily topically applied I-percent clindamycin gel for 12 weeks aims to prevent new lesions. This can be supplemented by 7-to 10-day courses of oral amoxicillin plus clavulanic acid or oral clindamycin to reduce lesion progression (Margesson, 2014). Other options are reviewed by Perng and coworkers (2017).
Other skin conditions that are discussed elsewhere in this book include hirsutism and melanoma (Chap. 63, p. 1203), cutaneous lupus (Chap. 59, p. 1140), hyperpigmentation (Chap. 4, p. 53), and skin lesions seen with infections (Chaps. 64 and 65).
Local skin care, oral antihistamines, and topical corticosteroids are commonly used for many dermatoses. Oral antihistamines are given for pruritus. Suitable options include irst-generation agents such s diphenhydramine (Benadryl), 25 to 50 mg every 6 hours, or chlorpheniramine (Chlor-Trimeton), 4 mg every 6 hours. Second-generation agents-Ioratadine (Claritin) 10 mg daily or cetirizine (Zyrtec) 5 or 10 mg daily-may produce less sedation and are also pregnancy category B.
Hundreds of topical corticosteroid preparations are available, and in the United States, these are categorized by potency into seven groups. For initial treatment of dermatological disorders, low-or moderate-potency agents are preferred. Low-potency agents include those in groups 6 and 7, such as I-percent hydrocortisone or 0.05-percent desonide (DesOwen). Moderate-potency drugs are in groups 5, 4, and 3-such as O.I-percent triamcinolone acetonide (Aristocort) or O.I-percent mometasone furoate (Elocon). High-potency medications are in group 2, such as 0.05-percent betamethasone dipropionate (Diprolene). Ultrapotent agents in group 1, such as 0.05-percent clobetasol propionate (Temovate), are best reserved for refractory disorders and used for only 2 to 4 weeks on small surface areas.