Overview
This common and very pruritic disorder of pregnancy of unknown cause usually begins in the third trimester and resolves with delivery. Unlike herpes gestationis, postpartum onset or exacerbation is rare. Therapy is empiric and aims to control symptoms until the eruption abates following delivery.
First steps
- A topical high-potency to superpotent steroid cream applied two to four times daily. The strength should be guided by the severity of the pruritus.
- Oral diphenhydramine 25-50 mg 3 times daily.
Subsequent steps
Only rarely are systemic steroids required in this condition. Prescribe the minimum effective dose (initially usually 0.5-1 mg/kg in a single dose each morning) and rapidly taper to the lowest controlling dose.
Pitfalls
- Herpes gestationis initially may resemble the pruritic urticarial papules and plaques of pregnancy. A biopsy for direct immunofluorescence may be indicated.
- Scabies and other insect bites are morphologically similar to the pruritic papular rashes of pregnancy. Look carefully for burrows and take a history of animal exposure.
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