Assessment of Prurigo of Pregnancy in Patients Without Atopic Background

Abstract Background Prurigo of pregnancy (PP), a specific pregnancy dermatosis, has been associated with atopic background in the patient and/or family. However, this association was not validated in some studies, and cases without atopic background have been reported. Objectives To evaluate the clinical features of PP not related to atopic background and search for comorbid conditions in medical and obstetric records. Methods In this case series, patients with typical PP presentation (i.e. pruritic, discrete papulonodules on the extensor surfaces of extremities) diagnosed at Dermatology Clinics of tertiary referral hospitals were evaluated. Exclusion criteria included missing historic data, inadequate follow-up, laboratory test results suggestive of other pruritic condition, history of atopic disease, and family history of atopy. Clinical and laboratory data including course, response to treatment, serum total immunoglobulin E (IgE) level, and comorbidities in medical and obstetric history were collected. Results Twenty patients developed PP predominantly in late second or early third trimester. Nine patients reported that itch developed first vs 10 that lesions started first – one patient was uncertain about the onset. There was no recurrence postpartum (mean postpartum follow-up, 17 months). Serum total IgE level was elevated in 3 of 14 patients tested (21.4%). Obstetric history (n=12) included polymorphic eruption of pregnancy (PEP) (16.6%), PP (16.6%), and gestational pruritus (8.3%). Two of 20 patients (10%) had history of pruritic skin condition (prurigo nodularis, pruritus of unclear etiology) in the nonpregnant status. Medical history (n=20) included psychiatric disease (20%), ie, obsessive compulsive disorder (OCD), anxiety, hypothyroidism (10%), and obesity (10%). Conclusions PP can develop in patients without atopic background. This finding should be considered when classifying specific pregnancy dermatoses. A thorough medical and family history with a focus on atopy should be obtained in every patient with a gestational eruption, and patient should be counseled accordingly.