Retrospective Analysis of Skin Changes and Dermatoses Observed in Pregnants Applying to the Dermatology Outpatient Clinic

Öz

Background: Endocrinological, vascular or immunological changes during pregnancy can cause many diffe-rent clinical skin conditions. Objective was to make analysis of skin changes and dermatoses in pregnant patients who applied to the dermatology outpatient clinic. Materials and Methods: One hundred-twelve pregnant patients who have applied to the dermatology outpatient clinic from March 2021 to September 2022 were included to the study. Results: The mean age of the patients was 28.8±6.9 (min.18-max.44). 57.2% of the pregnant women were primigravida and 42,8% were multigravida. Pregnant women frequently applied to the outpatient clinic in the 2nd and 3rd trimesters (78.6%). Physiological skin changes were observed in 82.1% of the cases. Stria gravidarum was the most common (51.8%). Chloasma in 9%, varicose veins and spider angioma in 5.4%, linea nigra, acrochordon, cherry angioma and hair loss in 2.7%, hirsutism and ingrown nails in 1.8%, pyo-genic granuloma in 0.9% of the cases were observed. Skin infection was detected in 33.9% of the cases. Fungal infections (Dermatophytosis 9%, pityriasis versicolor 3.6%, candida 1.8%) were most common with 14.3%, scabies was the second most common with 11.6%. Pregnancy-specific dermatoses such as atopic eruption of pregnancy, pemphigoid gestationis and impetigo herpetiformis were seen in 2.7% of the cases. Non-pregnancy-specific dermatological diseases was 27.7%. Among these diseases, seborrheic dermatitis was 9%, psoriazis was 6.2%, acne and rosacea were 3.6%. Physiological changes of pregnancy and preg-nancy-specific dermatoses were significantly higher in the 3rd trimester compared to the first 2 trimesters (p=0.01, p=0.049, respectively) and in primigravidas compared to multigravidas (p=0.01, p=0.043, respec-tively). The recurrent outpatient clinical admissions were significantly higher in multigravidas than in primigravidas (p=0.0007) and in the 3rd trimester compared to the 1st and 2nd trimesters. (p=0.004). Conclusions: The most common skin disorders during pregnancy are physiological skin changes. Pregnancy specific dermatoses are rare. The most common skin infections in pregnancy are fungal infections. Skin changes and spesific dermatoses increase in the third trimester.

Dermatoloji Polikliniğine Başvuran Gebelerde Gözlenen Deri Değişiklikleri ve Dermatozların Retrospektif Analizi

Öz

Amaç: Gebelikte endokrinolojik, vasküler veya immünolojik değişiklikler deride birçok farklı klinik duruma neden olabilir. Dermatoloji polikliniğine başvuran gebe hastalarda gözlenen deri değişiklikleri ve dermatozların klinik analizini yapmak. Materyal ve metod: Çalışmaya Mart 2021 ile Eylül 2022 tarihleri arasında dermatoloji polikliniğine başvuran 112 gebe hasta dahil edildi. Bulgular: Hastaların yaş ortalaması 28,8±6.9 (min.18-max.44) idi. Gebelerin %58'i primigravida, %42'si multigravida idi. Gebeler sıklıkla 2. ve 3. trimesterde polikliniğe başvurdu (78.6%). Olguların %82.1'inde fizyolojik deri değişiklikleri görüldü. En sık stria gravidarum %51.8, kloazma %9, variköz venler ve spider anjiyom %5.4, linea nigra, akrokordon, cherry anjiyom ve saç dökülmesi %2.7, hirsutizm ve tırnak batması %1.8, pyojenik granülom %0.9 olguda görüldü. Olguların %33,9'unda cilt infeksiyonu saptandı. Mantar infeksiyonları (Dermatofitoz %9, pitriyazis versikolor %3.6, kandida %3.6) %14.3 ile en sık, uyuz %11.6 ile ikinci sıklıkta görüldü. Gebeliğin atopik erüpsiyonu, pemfigoid gestasyonis ve impetigo herpetiformis gibi gebeliğe özgü dermatozlar olgularının %2,7'sinde görüldü. Gebeliğe özgü olmayan dermatolojik hastalık oranı %27.7 iken, bu hastalıklar içinde seboreik dermatit %9, psoriazis %6.2 akne ve rozasea ise %3.6 oranındaydı. Primigravidalarda ve üçüncü trimesterde pigment değişiklikleri, stria gravidarum ve gebeliğe özgü dermatozlar istatistiksel olarak anlamlı düzeyde yüksekti (p<0.05). Multigravidalarda ve üçüncü trimesterde tekrarlayan poliklinik başvurularının istatistiksel olarak anlamlı olduğu gözlendi (p<0.05). Sonuç. Hamilelik sırasında en sık görülen deri değişikliği fizyolojik deri değişiklikleridir. Gebeliğe özgü dermatozlar nadir görülür. Gebelikte en sık görülen deri infeksiyonları mantar infeksiyonlarıdır. Üçüncü trimesterde deri değişiklikleri ve spesifik dermatozlar artar.

Anahtar Kelimeler

• gebelik
• dermatozlar
• cilt değişiklikleri
• poliklinik

Kaynakça

1. 1. Al-Fares SI, Jones SV, Black MM. The specific dermatoses of pregnancy: a re-appraisal. J Eur Acad Dermatol Venereol. 2001;15(3):197-206.
2. 2. Sharma A, Jharaik H, Sharma R, Chauhan S, Wadhwa D. Clini-cal study of pregnancy associated cutaneous changes. Int J Clin Obst Gynaecol. 2019;3(4):71-75.
3. 3. Carvalho MLR, Magalhães GM, Leite HV. Update on specific dermatoses of pregnancy. Rev Assoc Med Bras (1992). 2023;69(suppl 1):e2023S109.
4. 4. Alvarez Martinez D, Ricard-Gauthier D, Carbonne B, Kaya G. Peau et grossesse (Skin and pregnancy). Rev Med Suisse. 2022;18(775):596-603.
5. 5. Barnawi AM, Barnawi GM, Alamri AM. Women's Health: Most Common Physiologic and Pathologic Cutaneous Manifes-tations During Pregnancy. Cureus. 2021;13(7):e16539.
6. 6. Feliciani C, Genovese G, D'astolto R, Pontini P, Marzano AV. Autoimmune bullous diseases during pregnancy: insight into pathogenetic mechanisms and clinical features. G Ital Derma-tol Venereol. 2019;154(3):256-262.
7. 7. Lehrhoff S, Pomeranz MK. Specific dermatoses of pregnancy and their treatment. Dermatol Ther. 2013;26(4):274-284.
8. 8. Bechtel MA, Plotner A. Dermatoses of pregnancy. Clin Obstet Gynecol. 2015;58(1):104-111.

9. 9. Himeles JR, Pomeranz MK. Recognizing, Diagnosing, and Managing Pregnancy Dermatoses. Obstet Gynecol. 2022;140(4):679-695.
10. 10. Gallego Úbeda M, Delgado Téllez de Cepeda L, Campos Fernández de Sevilla Mde L, De Lorenzo Pinto A, Tutau Gómez F. Actualización del uso de fármacos durante el embarazo: ca-tegorías de riesgo (An update in drug use during pregnancy: risk classification). Farm Hosp. 2014;38(4):364-378.
11. 11. Haas DM, Marsh DJ, Dang DT, Parker CB, Wing DA, Simhan HN, et al. Prescription and Other Medication Use in Preg-nancy. Obstet Gynecol. 2018;131(5):789-798.
12. 12. Kannambal K, Tharini GK. A Screening Study on Dermatoses in Pregnancy. J Clin Diagn Res. 2017;11(5):WC01-WC05.
13. 13. Farahnik B, Park K, Kroumpouzos G, Murase J. Striae gravida-rum: Risk factors, prevention, and management. Int J Womens Dermatol. 2016;3(2):77-85.
14. 14. Ersoy E, Ersoy AO, Yasar Celik E, Tokmak A, Ozler S, Tasci Y. Is it possible to prevent striae gravidarum? J Chin Med Assoc. 2016;79(5):272-275.
15. 15. Karen JK, Pomeranz MK. Skin changes and diseases in preg-nancy. In: Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, editors. Fitzpatrick’s Dermatology In General Medicine. 7th edn. Mc Graw Hill publications; 2008:955–962.
16. 16. Barankin B, Silver SG, Carruthers A. The skin in pregnancy. J Cutan Med Surg 2002;6:236–40.
17. 17. Panicker VV, Riyaz N, Balachandran PK. A clinical study of cutaneous changes in pregnancy. J Epidemiol Glob Health. 2017;7(1):63-70.
18. 18. Dessinioti C, Lotti TM , Stratigos AJ , Damevska K,and Katsam-bas AD. Melasma.In: Katsambas AD, Lotti TM , Dessinioti C,D'erme AM,editors.Europen Handbook Dermatological Tre-atments. Springer-Verlag ,Berlin Heidelberg 2015:613-619
19. 19. Giménez García RM, Carrasco Molina S. Drug-Induced Hyper-pigmentation: Review and Case Series. J Am Board Fam Med. 2019;32(4):628-638.
20. 20. Tang-Lin L, Liew HM, Koh MJ, Allen JC, Tan TC. Prevalence of striae gravidarum in a multi-ethnic Asian population and the associated risk factors. Australas J Dermatol. 2017;58(3):e154-e155.
21. 21. Stefaniak AA, Pereira MP, Zeidler C, Ständer S. Pruritus in Pregnancy. Am J Clin Dermatol. 2022;23(2):231-246.
22. 22. Seçen Eİ, Desdicioğlu R, Yeğin GF, Bal C, Erdinç AS, Uygur D, et al. "Kaşıntı Semptomu ile Başvuran Gebelerde, Tanı Süreci ve Gebelik Sonuçlarının Retrospektif Analizi." Ankara Medical Jo-urnal 2021;21(4): 553-560.
23. 23. Szczęch J, Wiatrowski A, Hirnle L, Reich A. Prevalence and Relevance of Pruritus in Pregnancy. Biomed Res Int. 2017;2017:4238139.
24. 24. Weisshaar E, Szepietowski JC, Dalgard FJ, Garcovich S, Gieler U, Giménez-Arnau AM, et al. European S2k Guideline on Chro-nic Pruritus. Acta Derm Venereol. 2019;99(5):469-506.
25. 25. Nowak DA, Yeung J. Diagnosis and treatment of pruritus. Can Fam Physician. 2017;63(12):918-924. Erratum in: Can Fam Physician. 2018;64(2):92.
26. 26. Çınar SL, Kartal D, Uludağ SZ, Dolanbay M, Ertaş R, Avcı A, et al. The Skin Findings of Pregnant Women and Our Treatment Choices. A Turkish Experience: A 5-year Survey Kafkas J Med Sci 2016; 6(1):46–52.
27. 27. Murase JE, Heller MM, Butler DC. Safety of dermatologic medications in pregnancy and lactation: Part I. Pregnancy. J Am Acad Dermatol. 2014;70(3):401.e1-14; quiz 415.
28. 28. Uzuncakmak TK, Bayazit S, Askin O, Kutlubay Z. Demographic features and seasonal variation in adult and pediatric seborr-heic dermatitis: A cross-sectional, single-center, hospital-based study. South. Clin. Ist. Euras. 2021;32(2):121-124.
29. 29. Tauscher AE, Fleischer AB Jr, Phelps KC, Feldman SR. Psoriasis and pregnancy. J Cutan Med Surg 2002;6:561-570.
30. 30. Vena GA, Cassano N, Bellia G, Colombo D. Psoriasis in preg-nancy: challenges and solutions. Psoriasis (Auckl). 2015;5:83-95.