Diagnosis is one of exclusion. Serum bile acid levels are elevated but not greater than concentrations expected for normal pregnancy, and aminotransferase levels are normal. Serology specific for PC is negative. Many women with eczema of pregnancy have elevated serum IgE levels, which are not seen with the two other AEP dermatoses (Ambros-Rudolph, 201r1).
For all three manifestations, skin lesions and pruritus are usually controlled with low-or moderate-potency topical corticosteroids and oral antihistamines. For severe eczema, second-line agents include short-course ultrapotent topical corticosteroids. In some cases, however, an oral corticosteroid, narrow-band ultraviolet B, or cyclosporine is required (Lehrhof, 2013).
pregnancy. Some of those chronic conditions are considered here.
his common chronic dermatosis is unpredictably afected by pregnancy and, if necessary, is treated with benzoyl peroxide alone or coupled with either topical erythromycin or topical clindamycin (Zaenglein, 2016). In these combinations, benzoyl peroxide minimizes Propionibacterium acnes drug resistance. Azelaic acid is another comedolytic agent, which is category B. Topical salicylic acid is category C, but amounts in over-the-counter products are considered safe (Murase, 2014). Topical retinoids, which include tretinoin and adapalene, also appear safe, are category C drugs, but are probably best avoided during pregnancy, especially during the irst trimester (Kaplan, 2015; Panchaud, 2012). Topical tazarotene is contraindicated. For more severe cases, oral antibiotics that include erythromycin, azithromycin, cephalexin, or amoxicillin may be coupled with benzoyl peroxide. Systemic antibiotics are ideally delayed until the second trimester, and therapy duration limited to 4 to 6 weeks (Chien, 2016).
his chronic dermatosis also has a variable course during pregnancy, however, postpartum lares are common (Oumeish, 2006). Emollients alone are given initially, and low-or moderate-potency topical corticosteroids can be added. In resistant cases, restrained use of high-potency or ultrapotent corticosteroids appears safe in the second and third trimesters. Ultraviolet B phototherapy can be used as a second-line option. Last, cyclosporine, systemic corticosteroids, or tumor necrosis factor (TNF)-a antagonists that include adalimumab, etanercept, and inliximab are third-tier agents for pregnancy (Bae, 2012). Overall, data do not support an increased risk of adverse pregnancy outcomes with psoriasis (Bobotsis, 2016). With severe disease, a small increased risk for low-birthweight neonates was found by some (Lima, 2012; Yang, 2011). Also, in general, psoriatic patients have higher associated rates of depression (Bandoli, 2017; Cohen, 2016).