A prospective study of 200 women with dermatoses of pregnancy correlating clinical findings with hormonal and immunopathological profiles
A prospective study of 200 women with dermatoses of pregnancy correlating clinical findings with hormonal and immunopathological profiles
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一项对 200 名患有妊娠皮肤病的女性进行的前瞻性研究，将临床结果与激素和免疫病理学特征相关联
DOI：
10.1046/j.1365-2133.1999.02923.x
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发表时间：
1999
影响因子：
10.3
通讯作者：
M. M. Black
中科院分区：
文献类型：
--
作者：
S. Jones;S. Hern;C. Nelson;P. T. Seed;M. M. Black
1994年，我们设立了一间妊娠皮肤病专科诊所，以改善对有皮肤问题的孕妇的护理，并提高我们对妊娠皮肤病的一般认识。该诊所提供了一个包含200名女性的大型数据库，为为期2年的前瞻性研究奠定了基础。在每种情况下，皮肤病诊断都是根据临床标准明确定义的，并在适当情况下获得组织病理学和皮肤直接免疫荧光的额外帮助。我们纳入了一些诊断相对较轻的患者，因为这反映了我们医院和当地人口中助产士、全科医生和产科医生的转诊模式。我们的研究结果表明，所有患者的特殊皮肤病的妊娠符合良好的分类建立的Holmes和Black在1983年。本文研究了125例妊娠期多形疹（PEP）和妊高征患者血清中雌二醇、人绒毛膜促性腺激素（hCG）和皮质醇的变化，并与138例正常孕妇作对照。对于前列腺炎性毛囊炎（PF），测定血清雄激素以确定这些激素是否升高。几乎所有患者都在产后进行了随访，包括母体和胎儿预后（一些患者不幸失访）。许多患者是经产妇（47%），并在妊娠晚期（49%）。 这项研究表明，怀孕期间湿疹的患病率出奇的高。早期文献中称为妊娠期湿疹的病例可能实际上是湿疹，因此解释了本研究中湿疹的发生率较低。激素分析显示PEP患者血清皮质醇水平与正常妊娠对照组相比显著降低（P = 0.03），尽管hCG和雌二醇无差异。 与对照组相比，PF患者的血清雄激素水平没有显著升高。PF组和妊娠期类天疱疮组的体重（通过个体化出生体重比分析）均显著降低。在PEP和PF组中，男性/女性婴儿比例为2：1，在以前的研究中没有注意到。 在所有研究病例中，妊娠皮肤病对母体或胎儿结局均无不良影响。这项研究表明，所有患者都符合先前对妊娠期特定皮肤病的分类标准，尽管我们现在也强调了妊娠期湿疹的频率并推测了可能的原因。无妊娠丘疹性皮炎病例。我们认为专科诊所是一项重要的服务，它改善了对这些妇女的管理，并确定了进一步研究的领域。
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.