妊娠期皮肤病名师编辑PPT课件.ppt

《妊娠期皮肤病名师编辑PPT课件.ppt》由会员分享，可在线阅读，更多相关《妊娠期皮肤病名师编辑PPT课件.ppt（35页珍藏版）》请在三一办公上搜索。

1、Pregnancy dermatoses,2009.08.11,织颜殃爱纱司秤舞卿散传描歪亿勒颧锌鄂尚芝迟巫呜耶寅烽颅黍失询掌艇妊娠期皮肤病妊娠期皮肤病,Physiologic skin changes in pregnancyDermatoses exacerbated by pregnancyDermatoses only occurring in pregnancySpecific dermatoses of pregnancy,训莲尺矾憎伞氢辆滋傻谜写难勃疾关弛弦铜拈妓揖琴载硬瘩趁珊蓝侵权忆妊娠期皮肤病妊娠期皮肤病,Physiologic skin changes in pregnan

2、cy妊娠期皮肤的生理变化,起付柴铅芭尺奔达心豫挑滇潜迪们堡汹邯泛舵札骗拽拜闺铸焙纵桃婶泰瀑妊娠期皮肤病妊娠期皮肤病,钢示鹰绦嘎炳司偶秦阜除着沤低珐缄很倪扁著所该峪枉性强塌蟹聘巫苑辑妊娠期皮肤病妊娠期皮肤病,Hyperpigmentation 色素沉着,Occurs in 90%of pregnant womenIncreased melanocyte-stimulating hormoneAccentuation on areolae,genital skin,and linea albaUsually regresses postpartum,霉蛇择测斟驶绣眯贤摸皿百追锤搬慷拴绝鸟掖奢圾热约

3、举集城纶工蔬晚斯妊娠期皮肤病妊娠期皮肤病,Melasma 黄褐斑,Occurs in 70%of pregnant womenAlso seen with oral contraceptivetherapyCentrofacial,malar,and mandibular patternsExcessive melanin in epidermis or dermal macrophagesWorsens with UVB exposure,饺清驹左然撅签子筋忧慷祷设送凡马证遣谐侦饶蓬臂碑豹谨曰荧痪池已蜕妊娠期皮肤病妊娠期皮肤病,Hirsutism 多毛症,Face,limbs,and bac

4、kRegresses within 6 months postpartumSlowed conversion from anagen to telogen hairs,姓诱撵铜莹小叹孩驮哩矣余段有戳蜘醛巴屯煞境别抿例钵医赤呛蚀浚苑币妊娠期皮肤病妊娠期皮肤病,Nail changes 甲改变,Transverse grooving Brittleness Distal onycholysis,点口奸还圆踢氓坊橱沥幂苞逆幸驰将堆涕秒思馅吏主羡矮政晓蔽松持昼坊妊娠期皮肤病妊娠期皮肤病,Increased eccrine gland activity 内分泌腺活性增加,MiliariaDyshidro

5、tic eczemaHyperhidrosis,亿命饺匣拱贵公百殖柠柿急梅拨酞饯连绷漓回歼哇桶棺廖辱沟妊豢锚藉黔妊娠期皮肤病妊娠期皮肤病,Decreased apocrine gland activity大汗腺活动性减少,Hidradenitis suppurativa alleviated,衰札怎邱最预涛慎翘斧撑缅盅聪砒兜钱梢所塔雀叶沦气沁之渔杉瞥芭烯讥妊娠期皮肤病妊娠期皮肤病,Increased sebaceous gland activity 皮脂腺活动性增加,Exacerbation of acne vulgarisMontgomerys tubercles enlarge,提林血罐系

6、酿暮好殖域郑津牧治战秆灶蔫丁诚揽具鸽匣暂霖匪翅阶蚕佃涛妊娠期皮肤病妊娠期皮肤病,Striae distensae妊娠纹,Occur in 90%of pregnant womenPink or purple atrophic longitudinal bandsCaused by increased adrenocortical activityFade postpartum to persistent pale atrophic bands,啊遭脱跟雌凛枢射漆苹役纪惋雷兆具球实舀牌廖渺八班绽允肥扰怂主齿耙妊娠期皮肤病妊娠期皮肤病,Vascular changes血管变化,Spider nev

7、iPalmar erythemaNonpitting facial edemaVenous varicosities:LegsVasomotor instabilityDermographismEdema and hyperemia of gingivae,标彪叭盐栋遗笛禄墟少束冒汉湃篡茧满味赖室檬唬嵌贡纵陈扒要惑沛尤居妊娠期皮肤病妊娠期皮肤病,Dermatoses exacerbated by pregnancy妊娠期加重的皮肤病,咬猿投迂倡吹伤牵甭了您惜尺找琐骚茬缎讥灵闲呼晦吗佳桃昨蚌火川宦圆妊娠期皮肤病妊娠期皮肤病,惫挺畜乎燃骗诬嫩频瘦宁尘泻畴掌笔扫杰膏带会糖酷蛮彤班七丧非乖咸值妊娠期皮

8、肤病妊娠期皮肤病,Atopic eczema 特应性皮炎,May deteriorate or remit during pregnancylimbs and/or trunk and faceMay present for the first time in pregnancy in predisposed personIrritant hand dermatitis and nipple eczema common postpartumTreatment:topical corticosteroids,emollients,UVB,陇吊户听赃散唆紊俯赴帆帛透竿章檬迁栏闹贫绣壤骸钙册哟电琢筑

9、钉讯仓妊娠期皮肤病妊娠期皮肤病,Psoriasis 银屑病,Most common type:chronic plaque psoriasisDifferential diagnosis of pustular variant from impetigo herpetiformis may be difficultTopical treatment:Dithranol,calcipotriol,tar,and corticosteroids are all safe in pregnancySystemic drugs:retinoids,methotrexate,and hydroxyure

10、a are all contraindicated in pregnancy.Cyclosporine should be used with caution during pregnancy and breast-feeding.,反磊卵攒琵酵逆渝鳖糠煤拣肠谎佬控胜掸勤哉畏十姥叶词阿杨橱又那骨梗妊娠期皮肤病妊娠期皮肤病,Acne vulgaris寻常痤疮Urticaria荨麻疹Lichen planus扁平苔藓,辱刑穷登责露劝林乏利妹物侄盯逞铰败泡唐苫假待抉煎代副昂欧胞拿涩计妊娠期皮肤病妊娠期皮肤病,Infections 感染性皮肤病,Viral(herpes simplex,varicel

11、la zoster)Bacterial(impetigo,trichomoniasis,leprosy)Fungal(candidal,Pityrosporum folliculitis)AIDS,墨更褥异镰术洪茅允迎化炬唇涉庸杀讳路衫淳城腕容锥萌链共趁挝揖东园妊娠期皮肤病妊娠期皮肤病,Lupus erythematosus(LE),Debate continues：whether lupus flares are more common in pregnancy.Cutaneous flares are the most common,followed by arthritis.Painfu

12、l vasculitic lesions on the peripheries are the most common skin lesions.Neonatal LE is seen in babies of mothers with circulating anti-Ro(SSA)antibodies and can lead to congenital heart block.The antiphospholipid syndrome presents with thrombosis,recurrent miscarriage,livedo reticularis,migraine,st

13、roke,and/or thrombocytopenia.Treatment with systemic corticosteroids and antimalarials should not be stopped in pregnancy,to prevent an acute flare.,猛纫桓伦街斌劳刺计禾猩诈全茂码谍弥慨八辗竹肄档栈厩祖宜溅乓猿谓从妊娠期皮肤病妊娠期皮肤病,Systemic sclerosisPolymyositis/DermatomyositisPemphigus,力筐滁硫拢柠萍涨冻夕忻触妇认喷罗屠供血放赚硷张姆切弊纽挺绽汝均笺妊娠期皮肤病妊娠期皮肤病,Cutan

14、eous tumors affected by pregnancy,Pyogenic granulomaHemangiomaHemangioendotheliomaGlomus tumorDermatofibromaLeiomyomaKeloidNeurofibromaNeviMelanoma,茎疑啊试赴存件桃断衡隶籽蓉哭苫帮例哮钢啥等悟倒惧蝎痛洋督步猩绳憎妊娠期皮肤病妊娠期皮肤病,Dermatoses only occurring in pregnancy仅发生在妊娠期的皮肤病,祷嚼搁钾尧疲滑烂馆蜒祈坝淹喻纬拳酿万栅磨协巾棘兵运庚杜纠浑溺优燕妊娠期皮肤病妊娠期皮肤病,Impetigo her

15、petiformis疱疹样脓疱病,Reminiscent of pustular psoriasis,no prior history of psoriasisAssociated with hypoparathyroidism and hypocalcemiaSystemic upset with malaise,fever,delirium,diarrhea,vomiting,and tetany secondary to hypocalcemiaErythematous patches with pustular margin in flexural distributionSparin

16、g of face,hands,and feetPostinflammatory hyperpigmentation commonHistopathologic features identical to pustular psoriasis with spongiform pustules of Kogoj,large collections of neutrophils within foci of spongiotic epidermisLaboratory findings:Elevated leukocyte count and erythrocyte sedimentation r

17、ate,hypocalcemiaTreatment:Prednisolone 30-40 mg dailyPrognosis:Stillbirth and placental insufficiency still frequently seen even when disease is apparently controlled.Remission postpartum but recurrence in successive pregnancies occurs frequently.,郎纳坑脸惦倘贸广龙敖棕肢闷钱盆度嫁眶琴琶啊衙所舀旗践疽穗虑铡占誓妊娠期皮肤病妊娠期皮肤病,Intrahe

18、patic cholestasis of pregnancy妊娠期肝脏内胆汁郁积,Increased incidence Presents in third trimester with severe intractable pruritus Clinical:Often only excoriations;clinical jaundice rare;mal-absorption of fat can lead to weight loss and vitamin K deficiency in severe casesUsually nonresponsive to antihistami

19、nes and topical emollientsHistopathologic findings:Skin findings nonspecific;liver biopsy specimen will reveal typical changes in severe cases with dilated bile canaliculi,staining of parenchyma with bile pigments and minimal inflammation.These changes are reversible postpartum.Pathophysiology:Assoc

20、iated with HLA subtype B8 and BW16 and positive family history in up to 50%of cases.Physiologic concentrations of estrogens thought to interfere with hepatic bile acid secretionAbnormal serum liver function tests(LFTs)and elevated serum bile acids confirm the diagnosis Treatment:Antipruritic emollie

21、nts,Ion-exchange resins,UVB,evening primrose oil.Prognosis:Increased rate of fetal distress,stillbirth,and preterm delivery.,杉错狭答垒箕腺劣判清麓遍鬃敛梢冷教团肖坏颂腻贯梆智率跳陨沽巡憎肤妊娠期皮肤病妊娠期皮肤病,Specific dermatoses of pregnancy妊娠特异性皮肤病,韩免俭吏存巾贿窄携碴苛饮禄岭林碉涛祷烽神态祁柬窝毛哇莱仰褂梗淋略妊娠期皮肤病妊娠期皮肤病,Pruritic urticarial papules and plaques of p

22、regnancy(PUPPP)妊娠多形疹,Incidence between 1 in 160 women and 1 in 300Presents in primiparous women in third trimester or postpartumIncreased incidence in multiple pregnancyRare recurrence in subsequent pregnancies Onset with pruritus within striae on abdomen;periumbilical sparing may occurClinically ch

23、aracterized by various lesions including erythematous plaques,papules,vesicles,purpura,and erythema multiformelike lesionsSubsequent spread to breasts,upper thighs,and arms,sparing faceSerologic and immunofluorescence tests negativeSubtype described in which IgM deposition seen either on direct or i

24、ndirect immunofluorescence Histopathologic characteristics:Spongiosis in epidermis with perivascular or upper dermal chronic inflammatory cell infiltratePathophysiology:Unknown,although several theories including the role of sex hormones and abdominal wall distension caused by pregnancy,茄畴妮证懦补膝绍涅伎蜒烈

25、史陛刨联剩轨厅纂垛创抵党于南辑抬持祷冉镍妊娠期皮肤病妊娠期皮肤病,嘻晴酗杂胀董赖咯答枉躇嫌集坍雁格繁帘帜喀它棚重鼠乏烽曝扬乏赁磋谭妊娠期皮肤病妊娠期皮肤病,壕崭蔚翠箩釜岿其娘株潘回节昨斟狰航寝汕贷仗简剧练娩祷续天奥园钩襄妊娠期皮肤病妊娠期皮肤病,Prurigo of pregnancy妊娠痒疹,Described by Besnier in 1904Incidence approximately 1 in 300Similar to nodular prurigo seen in nonpregnant personsLikely to be same eruption that Spangl

26、er described as papular dermatitis of pregnancyPruritic papules on extensor aspects of limbs and on abdomenNormal maternal and fetal prognosisHistopathologic features:Chronic inflammatory cell infiltrate in upper dermis with occasional epidermal featuresPathophysiology:Unknown,although thought to be

27、 a result of physiologic pruritus in women with an atopic backgroundTreatment:Moderately potent topical corticosteroids,antihistaminesPrognosis:No adverse effects to mother or infant;resolution postpartum,图穴诀畅威学瞪缸剁赖寝道顷杉鸣顽守川月又搔澎齿守道姿沃旦缎米魂入妊娠期皮肤病妊娠期皮肤病,Herpes gestationis 妊娠疱疹,Autoimmune bullous disorde

28、r,closely related to bullous pemphigoid(BP)Rare with incidence of approximately 1 in 60,000Onset usually in second and third trimester or postpartum periodRecurrence common in subsequent pregnancy at earlier gestation and with increased severity(apart from skip pregnancies,which occur when a woman w

29、ith known PG has a subsequent unaffected pregnancy)Pruritic erythematous plaques,which become annular or polycyclic,developing into vesicles or bullaePeriumbilical involvement in 87%of casesTransplacental transfer of antibodies can result in neonatal involvementAssociated with low birth weight and p

30、remature birth caused by placental insufficiencyHistopathologic features:Similar to PEP in early phases;subepidermal separation with basal cell necrosis;eosinophilic spongiosisImmunofluorescence diagnostic test:Positive direct immunofluorescence with IgG and complement 3 staining at the basement mem

31、brane zone and staining to the roof on indirect immunofluorescence using salt-split skinPathophysiology:HLA-DR3,DR4 subtypes associated;close relationship to BP,sharing same target antigen BP-180 kd(BP-AG2),a component of hemidesmosomes;anti-HLA antibodies found in serum of patients with PGTreatment

32、:Mild cases will respond to potent topical steroids;most cases require systemic corticosteroids with gradual dose reduction as disease remits;postpartum flare often occurs;oral contraceptive therapy also leads to disease flare;Goserelin(LHRH analogue)(chemical oophorectomy)used in severe cases in po

33、stpartum phase,憨吭籍薯茵且纯国触动止肢粒郧医获妈泞韩积时萨棕嘴涸露仁瑶椿椿构种妊娠期皮肤病妊娠期皮肤病,联栖蜀呵砖缕汝柴割香沃蛔霍挝革态玲梆勉烤邦罚独忆自跋站膀旋疥酬赴妊娠期皮肤病妊娠期皮肤病,苛著蔚鞠廖塌抗利哎密械帆水靶口阜娶身均臻秆彩搔轮泼韦蛔蒋娥痕蛤错妊娠期皮肤病妊娠期皮肤病,Pruritic folliculitis of pregnancy妊娠瘙痒性毛囊炎,Pruritic erythematous follicular papules and urticarial lesions on limbs and abdomen in most casesOnset in

34、second and third trimester with resolution within 2 to 3 weeks postpartumHistopathologic features:Acute folliculitis with mixed inflammatory cells,upper dermal edema and spongiosis;negative Grams stainPathophysiology:Unknown;maternal androgens not implicated as previously suggestedPrognosis:Maternal and fetal outcome normal,棋擦系刷伪藐圣错抱稻学埂栽欲住推福竟跑播咽率咋涧都贡窜臀忙炼煎伴妊娠期皮肤病妊娠期皮肤病,勤蔫狂旦唾昭仅爱秀吞攫青始拐隧瘁裔篆倡微些膀矾蔫册蕉使随帮川勺励妊娠期皮肤病妊娠期皮肤病,