Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Net letter
2011:77:3;402-402
doi: 10.4103/0378-6323.79741
PMID: 21508591

Pattern and prevalence of physiological cutaneous changes in pregnancy: A study of 2000 antenatal women

Shagufta P Rathore1 , Shashi Gupta2 , Vipin Gupta1
1 Department of Dermatology, Government Medical College and Hospital, Jammu, Jammu and Kashmir-180 001, India
2 Department of Obstetrics and Gynecology, Government Medical College and Hospital, Jammu, Jammu and Kashmir-180 001, India

Correspondence Address:
Shagufta P Rathore
Department of Dermatology, Government Medical College and Hospital, Jammu, Jammu and Kashmir-180 001
India
How to cite this article:
Rathore SP, Gupta S, Gupta V. Pattern and prevalence of physiological cutaneous changes in pregnancy: A study of 2000 antenatal women. Indian J Dermatol Venereol Leprol 2011;77:402
Copyright: (C)2011 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

During pregnancy immunologic, endocrine, metabolic and vascular changes occur that make pregnant women particularly susceptible to changes of skin and its appendages. Whether physiologic or pathologic, these changes affect virtually every organ of pregnant women including the skin. Some of these changes are due to de novo production of a variety of protein and steroid hormones by the fetoplacental unit as well as the increased activity of maternal pituitary, thyroid and adrenal glands. [1]

Cutaneous changes and eruptions during pregnancy are exceedingly common and in some cases a cause for substantial anxiety on the part of the prospective mother. Some of these are benign and reversible after delivery whereas others can have potential effects on the fetus in terms of morbidity and mortality. [1] The present prospective study is an attempt to provide a framework for an effective approach to the spectrum of physiological cutaneous changes encountered in antenatal women.

Two thousand randomly selected, asymptomatic pregnant females, attending the Outpatient Department of Obstetrics and Gynecology, Govt. Medical College and Hospital, Jammu, for a routine antenatal checkup, irrespective of the period of gestation, were enrolled from October 2007 to September 2009. After an informed consent, a detailed history was recorded followed by complete general physical, relevant systemic and a detailed dermatological examination of all patients to study the physiological changes of skin and its appendages. Relevant clinical details were recorded and results compiled in tabulated form.

The age range of patients was 18 to 40 years (mean 26.42 ± 4.05); 63.55% cases were up to 25 years of age; 56.35% were primigravidae; 53.85% cases were in the third and 34.00% in the second trimester of pregnancy. Fifty-eight percent cases belonged to rural areas. 92.7% were housewives and most of them belonged to the lower-middle and lower socioeconomic classes.

Physiological cutaneous changes were seen in 87.55% cases, which included pigmentary changes in 85.9%, connective tissue changes in 64.8%, vascular changes in 25.5%, glandular changes in 13.9%, hair changes in 3.4%, and nail changes in 2.1% [Table - 1]. Other studies have reported physiological skin changes in up to 100% cases. [2],[3]

Table 1: Pattern and Prevalence of physiological cutaneous lesions in 2000 antenatal cases

Pigmentary changes were most common, seen in 85.9% cases which were consistent with earlier studies. [2],[3],[4] Melasma [Figure - 1] has been reported to occur in 50-70% of pregnant women. [4] It was seen in 50.8% of our cases, thus conforming to earlier findings. [2],[5] A very low prevalence has been reported by some studies. [3],[6],[7] The possible reason for discrepancy in prevalence could be the skin phototypes and racial differences. The commonest clinical pattern found was the centrofacial pattern (76%) which was consistent with earlier reports. [3],[4] Others have found the malar pattern to be the commonest. [5]

Figure 1: Melasma: Centrofacial pattern

Hyperpigmentation of the neck was seen in 12.9% cases whereas Muzaffar et al., [2] reported it in 24.2% cases. Pigmentary demarcation lines, known to appear for the first time during pregnancy were seen in 0.25% cases, similar to 0.3% by Rashmi et al. [3]

Striae gravidarum [Figure - 2] were observed in 63.9% cases, comparable to those reported earlier. [2],[3],[8] The most common site involved was the lower abdomen (92.7%), with an onset mostly during the second trimester, similar to that reported by Chang et al. [8] Familial and racial factors are said to play a role in their development. [8] None of our patients were aware of it.

Figure 2: Striae gravidarum: Pink-purple linear streaks

Vascular changes result from distention, instability and proliferation of vessels [9] and were seen in 25.5% cases. Non-pitting edema over the hands, feet and face was observed in 24.8% cases with an onset mostly in the third trimester . Muzaffar et al., [2] reported edema in 48.5% whereas Rashmi et al., [3] reported it in 9.8%. Varicosities [Figure - 3] were seen in 3.2% cases , comparable to the earlier studies. [2],[6] A higher prevalence of up to 40% has been reported. [9]

Figure 3: Varicosities in lower limbs

Palmar erythema was observed in 18.7% and spider angioma in 2.1% cases, consistent with other studies. [2],[4] Rashmi et al., [3] reported no case of palmar erythema. Saudeau et al., [7] observed vascular spiders in 53% pregnant women. This discrepancy could be due to erythema being readily appreciated in light-skinned people.

Gingivitis [Figure - 4] may occur in up to 100% of pregnant women with varying degree of severity; [4] 16.1% cases of gingivitis were seen which is in agreement with earlier reports. [2]

Figure 4: Gingivitis

The cause as well as significance of nail changes occurring in pregnancy is unknown but they have been described. [2],[3] These were seen in 2.1% of our cases. During pregnancy, conversion of hair from anagen to telogen is slowed down which accounts for observed increase in percentage of anagen hair and decrease in telogen hair. [2],[9] Hair changes were seen in 3.4% cases, comparable to those reported by Rashmi et al. [3] Muzaffer et al., [2] reported them in 12.8% cases.

As the knowledge accumulates regarding the interaction of pregnancy with skin diseases, it can be concluded that a variety of cutaneous lesions can be seen in pregnant women. Awareness about and recognition of their clinical presentation is important for correct diagnosis that will direct the most appropriate laboratory evaluation and careful management in an effort to minimize maternal and fetal morbidity.

References
1.
Kroumpouzos G, Cohen LM. Dermatoses of pregnancy. J Am Acad Dermatol 2001;45:1-19.
[Google Scholar]
2.
Muzaffar F, Hussain I, Haroon TS. Physiologic skin changes during pregnancy: A study of 140 cases. Int J Dermatol 1998;37:429-31.
[Google Scholar]
3.
Kumari R, Jaisankar TJ, Thappa DM. A clinical study of skin changes in pregnancy. Indian J Dermatol Venereol Leprol 2007;73:141.
[Google Scholar]
4.
Wong RC, Ellis CN. Physiologic changes in the skin during pregnancy. J Am Acad Dermatol 1984;10:929-40.
[Google Scholar]
5.
Goh CL, Dlova CN. A Retrospective Study on the Clinical Presentation and Treatment Outcome of Melasma in a Tertiary Dermatological Referral Centre in Singapore. Singapore Med J 1999; 40:455-8.
[Google Scholar]
6.
Raj S, Khopkar U, Kapasi A, Wadhwa SL. Skin in pregnancy. Indian J Dermatol Venereol Leprol 1992;58:84-8.
[Google Scholar]
7.
Saudeau L, Pierre F, Barruet K, Vaillant L, Lorette G. Physiological cutaneous signs in normal pregnancy: A study of 60 pregnant women. Ann Dermatol Venereol 1994;121:227-31.
[Google Scholar]
8.
Chang AL, Agredano YZ, Kimball AB. Risk factors associated with striae gravidarum. J Am Acad Dermatol 2004;51:881-5.
[Google Scholar]
9.
Winton GB, Lewis CW. Dermatoses of pregnancy. J Am Acad Dermatol 1982;6:977-8.
[Google Scholar]

Fulltext Views
3,355

PDF downloads
2,306
Show Sections