Clinical Spectrum and Maternal–Fetal Outcomes of Dermatoses of Pregnancy: A Cross-Sectional Study

Pregnancy is associated with numerous physiological and pathological skin changes due to hormonal fluctuations, immune modulation, and metabolic alterations. Dermatological manifestations during pregnancy may be classified into physiological changes, exacerbation of pre-existing dermatoses, and pregnancy-specific dermatoses. Pregnancy-specific dermatoses constitute a heterogeneous group of inflammatory skin disorders that occur exclusively during gestation or postpartum.

Hormonal changes such as increased estrogen and progesterone levels play a major role in skin alterations during pregnancy. These hormonal effects cause hyperpigmentation, vascular dilatation, and glandular changes. In addition, immunological adaptation during pregnancy results in suppression of cell-mediated immunity, which contributes to development of inflammatory dermatoses and increased susceptibility to infections.

The classification of pregnancy dermatoses has evolved over time. The currently accepted classification includes four major entities: atopic eruption of pregnancy (AEP), polymorphic eruption of pregnancy (PEP) is also called as pruritic urticarial papules and plaques of pregnancy (PUPP)], pemphigoid gestationis (PG), and intrahepatic cholestasis of pregnancy (ICP). These conditions commonly present with intense pruritus and characteristic skin lesions.

Atopic eruption of pregnancy is the most common pregnancy dermatosis and usually presents during early gestation with eczematous lesions and papules predominantly involving limbs and trunk. Polymorphic eruption of pregnancy, also known as pruritic urticarial papules and plaques of pregnancy, typically occurs during the third trimester and is associated with stretch marks of the abdomen.

Pemphigoid gestationis is a rare autoimmune blistering disorder characterized by periumbilical pruritic plaques and vesicles that may progress to bullous lesions. It is associated with increased risk of preterm delivery and fetal growth restriction. Intrahepatic cholestasis of pregnancy is characterized by generalized pruritus without primary skin lesions and is associated with increased risk of fetal distress and stillbirth.

The incidence of pregnancy dermatoses varies globally depending on ethnicity, parity, and socioeconomic factors. Studies have reported that most pregnancy-specific dermatoses occur during the third trimester and are more common in primigravida women.

Early identification of pregnancy dermatoses is crucial as certain conditions may have serious fetal consequences. Dermatological examination plays a vital role in diagnosis and monitoring. Hence, this study aims to evaluate the clinical spectrum and frequency of dermatoses of pregnancy and their maternal and fetal outcomes.

This is a hospital-based, cross-sectional and observational study was Department of Dermatology and Obstetrics at a tertiary care hospital from September 2024 to August 2025.

Study Population

Pregnant women attending antenatal clinics with dermatological complaints.

Sample Size

Sample size was calculated using prevalence rate of pregnancy dermatoses estimated at 30%, with 95% confidence interval and 8% margin of error. A total of 150 patients were included.

Inclusion Criteria

•             Pregnant women of any gestational age

•             Presence of dermatological manifestations during pregnancy

•             Willingness to participate in study

Exclusion Criteria

•             Dermatological disorders present before pregnancy

•             Drug-induced skin reactions

•             Chronic liver or autoimmune diseases

•             Infectious dermatoses unrelated to pregnancy

Methodology

All patients underwent detailed evaluation including:

1. Clinical Assessment

•             Detailed history including onset, duration, pruritus severity

•             Obstetric history including parity and gestational age

•             Family history of atopy or autoimmune disease

2. Dermatological Examination

•             Type of skin lesion

•             Distribution pattern

•             Presence of mucosal involvement

3. Laboratory Investigations

•             Complete blood count

•             Liver function test

•             Serum bile acids

•             Skin biopsy (in suspected pemphigoid gestationis)

•             Immunofluorescence study when indicated

4. Obstetric Evaluation

•             Fetal growth monitoring

•             Ultrasonography

•             Non-stress test

Statistical Analysis

Data were analyzed using SPSS software version 25. Frequency and percentages were calculated. Chi-square test was used to determine association between dermatosis type and obstetric outcomes. P-value <0.05 was considered statistically significant.

Table 1: Age Distribution

Majority of patients were in reproductive age group 20–30 years.

Table 2: Trimester of Onset

Most dermatoses occurred during third trimester.

Table 3: Types of Pregnancy Dermatoses

In table 3, Atopic eruption of pregnancy is common one when compared to polymorphic eruption of pregnancy.

Table 4: Clinical Manifestations

Pruritus was the most frequent presenting symptom.

Table 5: Parity Distribution

Pregnancy dermatoses were more common in primigravida women.

Table 6: Maternal and Fetal Outcomes

ICP showed highest risk of adverse fetal outcomes.

Dermatoses of pregnancy represent an important group of dermatological disorders that may significantly affect maternal comfort and fetal health. The present study demonstrated that Atopic eruption of pregnancy was the most common dermatosis. Previous studies have similarly reported Atopic eruption of pregnancy as the most frequent pregnancy dermatosis, particularly in primigravida women and during third trimester.

Atopic eruption of pregnancy was the most common dermatosis observed in the present study. It usually presents early in pregnancy with eczematous lesions. Research suggests that hormonal and immunological changes during pregnancy predispose individuals with atopic tendency to develop skin lesions.

Polymorphic eruption of pregnancy is believed to occur due to rapid abdominal distension leading to connective tissue damage and inflammatory response. It commonly originates in abdominal striae and spreads to thighs and buttocks. Studies indicate that PEP is benign and rarely affects fetal outcome.

Intrahepatic cholestasis of pregnancy was observed in 9.3% of cases. This condition presents with severe pruritus without primary skin lesions. ICP is associated with elevated bile acids and carries significant risk of fetal complications including stillbirth and preterm labor. Early diagnosis and treatment with ursodeoxycholic acid improves fetal outcomes.

Pemphigoid gestationis is a rare autoimmune blistering disorder caused by circulating antibodies against basement membrane proteins. It commonly begins around the umbilical region and progresses to blister formation. Studies indicate recurrence in subsequent pregnancies and association with premature delivery.

The present study demonstrated higher incidence of dermatoses among primigravida women, which is consistent with previous literature. Hormonal adaptation and immune modulation during first pregnancy may contribute to increased susceptibility.

Pruritus was the most common presenting symptom across all dermatoses. Severe pruritus significantly affects quality of life and may cause sleep disturbances and psychological stress.

Overall, early dermatological consultation during pregnancy facilitates prompt diagnosis and treatment. Multidisciplinary collaboration between dermatologists and obstetricians is essential to optimize maternal and fetal outcomes.

Dermatoses of pregnancy constitute a significant group of pregnancy-related dermatological disorders. Atopic eruption are the most common conditions, whereas intrahepatic cholestasis and pemphigoid gestationis are associated with fetal complications. Early diagnosis and multidisciplinary management are crucial for favorable maternal and neonatal outcomes. Routine dermatological screening during antenatal care can help in early detection and treatment.

1.      Sävervall C, Sand FL, Thomsen SF. Dermatoses of pregnancy. Dermatol Res Pract. 2015.

2.      Ambros-Rudolph CM. Dermatoses of pregnancy. J Dtsch Dermatol Ges. 2017.

3.      Kroumpouzos G. Specific dermatoses of pregnancy. Int J Womens Dermatol. 2016.

4.      Carvalho MLR. Update on specific dermatoses of pregnancy. Rev Assoc Med Bras. 2023.

5.      Alhomieed MF. Effect of pregnancy on dermatological disorders. Medicina. 2025.

6.      McSwiney NT. Pregnancy-specific dermatoses for resident physicians. Dermatol Clin. 2025.

7.      Yellumahanthi DK. Pregnancy dermatoses. Springer Dermatology Series. 2024.

8.      Stefaniak AA. Pruritus in pregnancy. Am J Clin Dermatol. 2022.

9.      Goldust M. Specific dermatoses of pregnancy review. G Ital Dermatol Venereol. 2019.

10.   Kurien G. Dermatoses of pregnancy. StatPearls Publishing. 2023.

11.   Singh SK. Dermatoses during pregnancy. J South Asian Feder Obstet Gynaecol. 2025.

12.   Roth MM. Dermatoses of pregnancy overview. Contemporary OB/GYN. 2022.

13.   Tunzi M. Common skin conditions during pregnancy. Am Fam Physician. 2023.

14.   Ambros-Rudolph CM. Specific dermatoses of pregnancy revisited. J Am Acad Dermatol. 2016.

15.   Bacq Y. Intrahepatic cholestasis of pregnancy. Lancet Gastroenterol Hepatol. 2019.

16.   Elling SV. Polymorphic eruption of pregnancy. Int J Dermatol. 2019.

17.   Saaqib Y. Specific dermatoses of pregnancy. J Pak Assoc Dermatol. 2024.

18.   Jamshidi A. Risk factors in intrahepatic cholestasis. BMC Pregnancy Childbirth. 2025.

19.   Zhang Q. Pregnancy-associated autoimmune dermatoses. J Transl Autoimmun. 2024.

20.   Cassalia F. Pregnancy and inflammatory dermatoses outcomes. J Clin Aesthetic Dermatol. 2024.

21.   Ren Y. Hormonal dermatology in pregnancy. J Clin Med. 2025.

22.   Nour SA. Maternal-fetal dermatology innovations. Clin Dermatol. 2025.

23.   Vora R. Pregnancy and skin disorders. J Family Med Prim Care. 2018.

24.   Mehedintu C. Pregnancy-specific dermatoses case review. Medicina. 2022.

Panicker VV. Clinical study of cutaneous changes in pregnancy. J Epidemiol Glob Health. 2017.