The dermatoses of pregnancy can be classified into the following 3 groups: physiologic skin changes in pregnancy, dermatoses and cutaneous tumors affected by pregnancy, and specific dermatoses of pregnancy. Correct diagnosis and classification are essential for the treatment of these disorders, when necessary. Laboratory investigations are required when the diagnosis remains in question despite a careful history and thorough physical examination. A discussion with the pregnant woman about the nature of her skin condition, and the possible fetal risks associated with it, is imperative. (J Am Acad Dermatol 2001;45:1-19.) Learning objective: At the conclusion of this learning activity, participants should be familiar with the dermatoses of pregnancy and the proposed classification of them into 3 main categories. Participants should also have a better understanding of the current knowledge of these conditions to aid in evaluating the patient with a pregnancy dermatosis.

Dermatoses of pregnancy.

A postal questionnaire was used in a nationwide case control study of women with scleroderma to investigate whether there was an increased rate of spontaneous abortion before the onset of the disease. The results from 155 case control pairs studied showed that the women with scleroderma had twice the rate of spontaneous abortion and three times the rate of fertility problems (no successful pregnancy by the age of 35) of the control women. Previous uncontrolled studies have suggested that established scleroderma is associated with an adverse reproductive history. The results from this investigation suggest that the adverse reproductive history may antedate the clinical diagnosis of scleroderma by many years and may possibly have an aetiological role. Such a hypothesis is consistent with the, as yet unexplained, marked female excess in incidence of the disease, with the peak age of onset occurring shortly after the reproductive period.

https://ard.bmj.com/content/annrheumdis/47/6/441.full.pdf

Increased incidence of spontaneous abortion and infertility in women with scleroderma before disease onset: a controlled study.

We assessed fetal morbidity and mortality in women with systemic sclerosis (SSc). Women with a history of SSc and a concomitant pregnancy completed a detailed questionnaire about the pregnancy. These 48 subjects were age-matched and race-matched to 2 other groups of women (a rheumatoid arthritis group and a control group from the same neighborhood), all of whom had been pregnant at least once. There were no differences in the frequencies of miscarriage or perinatal death in the SSc group compared with the 2 control groups. Preterm births occurred slightly more frequently in both SSc patients and rheumatoid arthritis patients compared with the neighborhood control subjects. There were significantly more small full-term infants born to women with SSc. Interestingly, the increase in preterm births and small full-term babies occurred with equal frequency prior to and after the onset of disease. Although close monitoring for premature birth and intrauterine growth retardation is necessary, we conclude that an uneventful, healthy pregnancy is possible for women with SSc. Those with early, rapidly progressive, diffuse skin thickening should avoid becoming pregnant since, intrinsically, they are at higher risk of developing renal crisis.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/anr.1780320207

Pregnancy in women with systemic sclerosis.

The Interaction of Pregnancy and the Rheumatic Diseases

Pregnancy has been reported infrequently in patients with systemic sclerosis. Consequently, the outcome and appropriate management of such patients is uncertain. We review the obstetric experience of 19 female patients with systemic sclerosis, and report 2 women in whom 3 pregnancies occurred during the course of disease. Maternal complications included hypertension during 2 of these pregnancies and congestive heart failure during 1. There were 2 premature deliveries, although all 3 infants survived. Our experience with these patients and a review of the available literature suggest that, in patients with systemic sclerosis, fertility may be reduced and complications of pregnancy may be more frequent.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/art.1780280227

Winkelmann Rk

Papers

Scleroderma and pregnancy.