Pruritus in pregnancy and childhood--do we really consider all relevant differential diagnoses?
During pregnancy and also during childhood, pruritus can have manifold aetiologies and should therefore always be taken seriously. In pregnancy, pruritus is the main dermatological symptom, occurring in 18% of women. Pregnancy-specific dermatological diseases such as polymorphic eruption of pregnancy (PEP), Pemphigoid (Herpes) gestationis, Pruritus gravidarum are accompanied by severe pruritus and scratching. In children, it mainly occurs along with dermatoses but in rare cases with systemic diseases such as renal or liver failure. Mostly, it appears in the setting of atopic dermatitis (AD). Both groups of patients require therapeutic regimens of their own. The use of topical and systemic treatments depends on the underlying aetiology of the pruritus and the stage and status of the skin. Because of potential effects on the fetus, the treatment of pruritus in pregnancy requires prudent consideration of whether the severity of the underlying disease warrants treatment and selection of the safest treatments available. Systemic treatments such as systemic glucocorticosteroids, a restricted number of antihistamines and ultraviolet phototherapy may be necessary in severe and generalized forms of pruritus in pregnancy. In children, the physician has to consider that topically applied drugs may cause intoxication due to the different body volume/body surface proportion. The dosages of systemic drugs need to be adapted in children and ultraviolet phototherapy should be performed with caution due to possible longterm photo damage of the skin. In a two center approach, we wanted to highlight the major aetiologies of pruritus during pregnancy and in children and point out the mainstays of antipruritic therapy in these two challenging groups of patients according to our clinical experiences. For the future, it would be desirable for all disciplines involved (dermatologist, gynaecologist, paediatrician, general practitioner) to cooperate closely to expand the clinical and scientific knowledge of pruritus in these groups of pruritus patients.
Weisshaar
Elke
E
Department of Social Medicine, Occupational and Environmental Dermatology, University Hospital of Heidelberg, Germany. elke.weisshaar@med.uni-heidelberg.de
Diepgen
Thomas L
TL
Luger
Thomas A
TA
Seeliger
Stephan
S
Witteler
Ralf
R
Ständer
Sonja
S
D000982:Antipruritics / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology; D011537:Pruritus / Q000188:drug therapy / Q000209:etiology / Q000473:pathology
D000982:Antipruritics