Pruritus in pregnancy

Pruritus is reported by 23% to 38% of women during pregnancy, with 2% having severe itching, and it is often a burdensome symptom that may be the first sign of a pregnancy-specific disease. (1)

Approximately 11.8% to 76.4% will have a dermatosis specific to pregnancy as an underlying cause of their pruritus. (2) However, the true incidence of pruritus in pregnancy is unknown and is likely higher than previously reported. On average, itching in pregnancy starts at or just after 27 weeks of gestation. (3)

There are 5 dermatoses that are specific to pregnancy. These include;

• pemphigoid gestationis
• intrahepatic cholestasis of pregnancy
• polymorphic eruption of pregnancy
• atopic eruption of pregnancy
• pustular psoriasis of pregnancy.

In patients with pruritus in pregnancy, approximately 11.8% to 76.4% will have a dermatosis specific to pregnancy. (3)

Causes of itching in pregnancy but which are not specifically related to pregnancy include various diseases, such as; (2)

• renal, hepatic, and thyroid abnormalities
• iron deficiency anaemia
• malignancy
• rheumatic diseases
• drug reactions
• diabetes
• infestations
• neurologic disorders
• primary psychiatric disorders
• systemic infection such as hepatitis or HIV.

Note - the most common cause of generalized itch in pregnancy is dry skin, which is generalized across the body without any apparent causative skin lesions.

Treatment

The goal of treatment should be focused on the alleviation of symptoms and the prevention of any potential foetal adverse outcomes. Mild symptoms may be treated with reassurance, education, psychological strategies, antipruritic topical preparations, and weak steroidal ointments. (4) Patients should be advised to avoid anxiety and irritating clothing.

Skin barrier-related itching is treated initially with; (4)

• topical therapies, including emollients (water and lipids)
• corticosteroid creams and ointments
• immunomodulators
• capsaicin
• oral and topical antihistamines.

The topical therapies, in the form of creams, lotions, or ointments, target areas of the skin in close proximity to the stratum corneum. A combination of topical and systemic therapies may be needed to stop the itch-scratch cycle.

Therapy must be tailored to the individual patient and underlying cause. A high frequency of recommended use for topical agents and unpleasant side effects are common reasons for noncompliance with use, resulting in the failure of a specific treatment regimen. (4)

References

1. Patel MA, Aliporewala VM, Patel DA. Common Antifungal Drugs in Pregnancy: Risks and Precautions. J Obstet Gynaecol India. 2021 Dec;71(6):577-582.
2. Rudder M, Lefkowitz EG, Ruhama T, Firoz E. A review of pruritus in pregnancy. Obstet Med. 2021 Dec;14(4):204-210.
3. Szczęch J et al. Prevalence and Relevance of Pruritus in Pregnancy. Biomed Res Int. 2017;2017:4238139.
4. Yosipovitch G et al. Skin Barrier Damage and Itch: Review of Mechanisms, Topical Management and Future Directions. Acta Derm Venereol. 2019 Dec 01;99(13):1201-1209.