Pregnancy Itching and Skin Rash – Causes and Types

An itchy skin rash during pregnancy may occur due to a number of causes. However, pregnancy is usually not the main cause of the itchy skin rash in these conditions. Many of the causes of an itchy skin rash may be present even before conception. In these cases, pregnancy only serves to worsen the condition. In other cases, an itchy skin rash would have occurred even without pregnancy.

In both these scenarios, the causes of the itchy skin rash are non-specific and not directly related to pregnancy. An itchy skin in pregnant women is not always accompanied by a skin rash. Signs and symptoms other than a rash may also occur along with an itchy skin. In some cases, an itchy skin may occur on its own, without any accompanying signs and symptoms.

Itchy Skin During Pregnancy

Some underlying conditions in pregnant women may cause an itchy skin during pregnancy. The pregnant stage can exacerbate these conditions. In some cases, pregnancy can also act as a precipitating factor that triggers the onset of some condition that a pregnant woman might be predisposed to. This trigger function may be attributed to immunological, hormonal or unknown factors related to pregnancy.

Allergy is one of the most common conditions that can cause an itchy skin. Hormonal changes associated with pregnancy can exacerbate allergies that cause an itchy skin. For example, increased estrogen levels in pregnant women (and also in women who use hormonal contraceptives) can worsen allergies. To combat the itchy skin, antihistamines are usually prescribed. However, the use of antihistamines in pregnant women has been a subject of debate due to concern about the teratogenic properties of antihistamine drugs.

However, some antihistamines (such as chlorphenamine) have been shown to have a long safety record when given to pregnant women. In any case, pregnant women must use these drugs only when prescribed by a doctor or gynecologist.

Causes of Pregnancy Itchy

An itchy skin is common during the first trimester of pregnancy. If no other signs and symptoms are present, then an itchy skin during this period is not a cause for concern. The itching usually subsides spontaneously within a few weeks or a few months. Since an itchy skin is relatively more common in first time mothers, the cause is sometimes thought to be anxiety-related (psychogenic cause) although first time mothers may be more focused on pregnancy-related symptoms.

If itching is accompanied by visible skin rashes or other signs and symptoms, then the underlying cause should be investigated. This is especially pertinent if itching persists or gets worse, and starts to affect sleep and other activities. Also, certain causes of itching during pregnancy can also affect the fetus adversely. However, it is important to note that there are many causes of itchy skin rashes, irrespective of pregnancy.

Read more on itchy skin.

Pruritic urticarial papules and plaques of pregnancy

Pruritic urticarial papules and plaques of pregnancy (abbreviated as PUPPP) usually tend to occur during the third trimester of pregnancy or immediately after childbirth. Also known as polymorphic eruption of pregnancy (abbreviated as PEP), this condition is characterized by the appearance of small and red papules or spots in areas where the stretch marks are prominent.

Buttocks, thighs, and abdomen are the most commonly affected regions. Arms may also be involved in some cases. The papules and plaques are intensely itchy, and cause disruption of sleep and other normal activities. This condition usually resolves on its own after pregnancy. Treatment options include the use of antihistamines (such as chlorphenamine), corticosteroids (topical and oral), and emollients.

Polymorphic eruption of pregnancy is more common during first pregnancy. However, the condition may recur during subsequent pregnancies as well.

Prurigo gestationis

Prurigo gestationis is also known as the eczema of pregnancy. This condition is characterized by an appearance of tiny red spots on the skin during the early stages of disease. In the later stages, the skin becomes dry and rough, resulting in the appearance of cracks in the skin. The accompanying itching varies in severity.

Prurigo gestationis closely resembles polymorphic eruption of pregnancy, and affects the chest and the upper areas of the limbs. This condition is most likely to occur in the second trimester of pregnancy. Treatment includes the use of antihistamines (such as chlorphenamine), topical corticosteroids, and emollients. Prurigo gestationis should not be confused with atopic dermatitis, which is another condition that can aggravate during pregnancy.

Pemphigoid gestationis

Pemphigoid gestationis is a pregnancy-associated autoimmune disease that usually tends to occur during the third trimester of pregnancy. However, women in the latter part of the second trimester of pregnancy may also get affected. Pemphigoid gestationis is characterized by the appearance of tiny blisters and itchy patches on the skin. The itching starts around the umbilical region and is very intense.

The tiny blisters on the skin may progress to form large blisters (also known as bullae). The skin around the blisters may become rough and begin to crack. Due to its appearance, pemphigoid gestationis is also sometimes referred to as herpes gestationis. However, this condition is not caused by the herpes virus. Treatment includes the use of both topical and oral corticosteroids.

Pruritic folliculitis

Pruritic folliculitis is characterized by the appearance of small red spots or aseptic pus-filled pimples on the chest, abdomen, shoulders, and upper arms. The intensity of itching may range from mild to very severe. The pimples in pruritic folliculitis are often mistaken for acne. However, they are caused due to inflammation of the hair follicles. Folliculitis in pregnancy is rarely a result of infection. Pruritic folliculitis tends to occur during the third trimester of pregnancy. Treatment for this condition includes the use of antihistamines, topical corticosteroids, and antibiotics (in case of infection).

Obstetric cholestasis

Obstetric cholestasis is characterized by a persistent itch all over the body. This condition is a result of bile salts entering the bloodstream after the outflow of bile from the liver is diminished. A mild jaundice may also be present, with a yellowish discoloration of the sclera of the eye and the skin. Skin rash is not present.

However, excoriation may occur due to scratching. Obstetric cholestasis can occur during the third trimester of pregnancy, and can pose a risk to the developing fetus. Diagnosis of this condition is based on abnormal liver function tests. Treatment includes use of antihistamines, cholestyramine, and emollients.

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