Vaughan Jones S A, Hern S, Nelson-Piercy C, Seed P T, Black M M
St John's Institute of Dermatology, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, U.K.
Br J Dermatol. 1999 Jul;141(1):71-81. doi: 10.1046/j.1365-2133.1999.02923.x.
In 1994 we set up a specialist clinic for pregnancy dermatoses, both to improve the management of pregnant women with skin problems and to enhance our general understanding of the pregnancy dermatoses. This clinic has provided a large database of 200 women which has formed the basis for a prospective study over a 2-year period. In each case the dermatological diagnosis was clearly defined on clinical criteria, with additional help from histopathology and direct immunofluorescence of the skin where appropriate. We have included a number of patients who presented with relatively trivial diagnoses, as this reflects the referral patterns of our midwives, general practitioners and obstetricians within our hospital and local population. Our results show that all patients with specific dermatoses of pregnancy conformed well to the classification established by Holmes and Black in 1983. The role of the sex hormones [oestradiol, human chorionic gonadotrophin (hCG) and cortisol] in polymorphic eruption (PEP) and prurigo of pregnancy was studied in 125 cases and compared with 138 normal healthy pregnant controls. For pruritic folliculitis (PF), serum androgens were measured to establish if these were elevated. Nearly all patients were followed up postpartum, with respect to both maternal and fetal prognosis (some were unfortunately lost to follow-up). Many patients were primiparous (47%) and presented in their third trimester (49%). This study shows a surprisingly high prevalence of eczema during pregnancy. It is possible that earlier cases in the literature termed prurigo of pregnancy may in fact have been eczema, thus explaining the low incidence of prurigo in this study. Hormonal analysis showed a significant reduction in serum cortisol levels in patients with PEP compared with normal pregnant controls (P = 0.03), although hCG and oestradiol showed no differences. Serum androgens were not significantly elevated in patients with PF compared with controls. Birthweight (analysed by the individualized birthweight ratio) was significantly reduced in both the PF and pemphigoid gestationis groups. In the PEP and PF groups there was a male/female infant ratio of 2 : 1, not noted in previous studies. In all cases studied there were no adverse effects either on maternal or fetal outcome as a result of the pregnancy dermatosis. This study indicates that all patients fulfilled the criteria of the previous classification of the specific dermatoses of pregnancy, although we also now highlight the frequency of eczema in pregnancy and speculate as to possible causes. There were no cases of papular dermatitis of pregnancy. We feel that the specialist clinic is an important service which has improved the management of these women and identified areas for further research.
1994年，我们设立了妊娠皮肤病专科诊所，目的是改善对有皮肤问题的孕妇的管理，并增进我们对妊娠皮肤病的总体认识。该诊所提供了一个包含200名女性的大型数据库，这构成了一项为期2年的前瞻性研究的基础。在每一个病例中，皮肤病学诊断都依据临床标准明确界定，必要时还借助皮肤组织病理学和直接免疫荧光检查提供辅助。我们纳入了一些诊断相对轻微的患者，因为这反映了我们医院和当地人群中助产士、全科医生和产科医生的转诊模式。我们的研究结果表明，所有患有特定妊娠皮肤病的患者都完全符合霍姆斯和布莱克于1983年确立的分类标准。在125例患者中研究了性激素[雌二醇、人绒毛膜促性腺激素（hCG）和皮质醇]在妊娠多形疹（PEP）和妊娠痒疹中的作用，并与138名正常健康孕妇进行了对照。对于瘙痒性毛囊炎（PF），检测血清雄激素以确定其是否升高。几乎所有患者产后都接受了随访，涉及母婴预后（遗憾的是，有些患者失访了）。许多患者是初产妇（47%），且在妊娠晚期就诊（49%）。这项研究显示妊娠期间湿疹的患病率出奇地高。有可能文献中早期称为妊娠痒疹的病例实际上可能是湿疹，这就解释了本研究中痒疹发病率较低的原因。激素分析显示，与正常妊娠对照组相比，PEP患者血清皮质醇水平显著降低（P = 0.03），而hCG和雌二醇无差异。与对照组相比，PF患者血清雄激素未显著升高。PF组和妊娠类天疱疮组的出生体重（通过个体化出生体重比分析）均显著降低。在PEP组和PF组中，男婴与女婴的比例为2∶1，这在以往研究中未被提及。在所研究的所有病例中，妊娠皮肤病对母婴结局均无不良影响。这项研究表明，所有患者都符合先前特定妊娠皮肤病分类的标准，尽管我们现在也强调了妊娠期间湿疹的发生率，并推测了可能的原因。没有妊娠丘疹性皮炎的病例。我们认为专科诊所是一项重要的服务，它改善了对这些女性的管理，并确定了需要进一步研究的领域。
