妊娠皮肤病简介.ppt

按一下以編輯母片標題樣式,按一下以編輯母片,第二層,第三層,第四層,第五層,*,妊娠皮膚病簡介,生理的變化,Enlarged of the intermediate lobe of the pituitary gland,the,melanocyte,-stimulating hormone(MSH)became remarkably elevated by 8 weeks gestation,常見的變化-,Hyperpigmentation,90,%:,skin darkening;MSH and estrogen,Beginning early in pregnancy and more pronounced in naturally,hyperpigmented,areas such as,areolare,perineum and umbilicus and,axillae,and inner,thigns,Linea nigra,Face:,cholasma,or,melasma,;50%,sunscreens;Regress postpartum,dermal,melanosis,persist up to 10 years in 1/3 pts,2-5%,hydroxquinone,0.1%,tretinoin,gel or cream or 20%,azelaic,acid cream,cholasma,or,melasma,黑斑,or,肝斑,Linea nigra,常見的變化-,Navi,Pigmented,cutaneous,tumors commonly enlarge and darken during pregnancy,leading to their confusion with malignant melanomas.,6%changed in diameter over pregnancy,No evidence that they undergo malignant transformations,常見的變化-,Hair Growth,Growing hair phase is increased related to the resting hair phase,Estrogen prolong the growing hair phase and androgens cause enlargement of follicles,Telogen,effluvium,:abrupt hair loss beginning 1 to 4 months postpartum;self limited and restored in 6 to 12 months,常見的變化-,Vascular change,Augmented,cutaenous,blood flow:estrogen and decreased vascular resistance,Spider,angiomas,:2/3 white and 1/10 black,Palmar erythema,:2/3 white and 1/3 black,Papillary,hemangiomas,:5%,Pregnancy gingivitis,(epulis,):growth of the gum capillaries,Pyogenic granuloma,of pregnancy,(granuloma gravidarum,):oral cavity and arise from the gingival papillae,Spider,angiomas,Palmar erythema,Pregnancy gingivitis,(epulis,),Pyogenic granuloma,of pregnancy,妊娠紋,8090的孕婦,懷孕67個月後開始產生，除了肚子之外，大腿、腹股溝甚至胸部都有可能出現粉紅或紫紅色萎縮性斑紋。,除了荷爾蒙的影響，體重增加太快也是促成原因之一。,雖然在產後會慢慢變白、變細，,但很多人是無法完全恢復的,控制體重,含果酸的乳液或其他可促進,彈力纖維生成的妊娠霜，來緊緻皮膚，,預防妊娠紋產生。倘若妊娠紋已產生,，在產後且妊娠紋尚未變白前，,可接受脈衝光治療，有改善的機會。,Dermatoses,of pregnancy,1.6%,of women had significant,pruritus,at some time during,prengancy,Pruritus gravidarum,Prurutuc ureticarial,papules and plaques of pregnancy,Herpes,gestationis,Pruritus Gravidarum,0.6%,pregnancy with,pruritus,:mild variant of,intrahepatic cholestasis,of pregnancy,Scratching and excoriation,skin lesions,Hormone,genetics and,enviornmental,factors,Pruritic,urticarial papules and plaques of pregnancy,PUPPP in US;,Polymorphic,eruption of pregnancy(PEP)in UK,1/200 singleton,8/200 for twin,Pruritic cutaneous,eruption that usually appears late in pregnancy;abdomen firstly and then buttocks and thighs and extremities.,40%:urticarial;45%,erythematous,pattern;15%combination;face spared and common in,nulliparas,and seldom recurs in subsequent pregnancy.,Resemble herpes,gestationis,but no,veiscles,or,bullae,Prurigo,of pregnancy,Papular eruptions of pregnancy,Prurigo gestationis,and,papular,dermatitis,Prurigo gestationis,:small,pruritic,rapidly excoriated lesions on the forearms and trunk,No vesicles or,bullae,Onset at 25 to 30 weeks and may persist for 3 months after delivery,Recurrence is common,Oral antihistamines and topical,corticosteriod,creams,Perinatal,outcome:not affected,Herpes,gestationis,(1),Noninfectious disorder,Autoimmue pruritic,blistering skin eruption affects,multiparous,women in late pregnancy and may begin early in pregnancy or within a week or postpartum,Pemphioid gestationis,:,immunologically,similar to,bullous pemphgoid,1/5000 pregnancies,Extremely,pruritic,widespread eruption with lesions that vary from,erythematous,and edematous papules to large,tense vesicles and,bullae,.,Herpes,gestationis,(2),Topical,corticosterioids,and oral antihistamines,Orally,pregnisone,0.5 to 1 mg/kg daily,brings relief and inhibits formation of new lesions,The healed sites are not scarred but frequently are,hyperpigmented,Refractory cases:,immunosuppresives,such as,cyclophosphamide,methotrexazte,and,cyclosporine,.,Bullous pemphigoid,:,plasmapheresis,and high dose IG therapy,Herpes,gestationis,(3),Reports of association with,preterm,birth,stillbirths and growth restriction,Increased surveillance is recommended,Lesions similar to those of the mother develop in up to 10%of neonates,Preexisting skin disease,Acne:,Isotretinoin,etretinate,and,tretinoin,are strictly contradicted in pregnancy,teratogenic,Pregnancy:topically applied,benzoyl,peroxide and,clindamycin,or erythromycin gel,Topical,tretinoin,is thought to pose no significant,teratogenic,risk,Preexisting skin disease(2),Psoriasis improves in up to 50%during pregnancy and 20%worse,Localized:Topical,corticosteroids,calciportriene,antrhalin,and,tacrolimus,Generalized mild disease:UV-B,phtotherapy,or plus,psoralens,and oral,cyclosporing,if unsuccessful,Moderate and severe:plus topical or oral,corticosteriods,Coal tar,derviatives,as well as oral and systemic,immunosupressives,(MTX,cyclosporine,tacrolimus,)are avoided,Thank you for your attention,