Atopic Eruption of Pregnancy
A 37-year-old primigravid woman presented to the dermatology clinic at 30 weeks’ gestation with a 4-month history of pruritic pustules on her torso, arms, and legs. On examination, there were papules, nodules, and follicular pustules with surrounding erythema on the trunk, arms, and legs, with no lesions on the palms and soles (Panel A shows the left arm, and Panel B a closer view of the left arm). Topical and oral glucocorticoids were prescribed to treat a possible diagnosis of polymorphic eruption of pregnancy, but the lesions did not abate. On the day of the initial presentation, a skin biopsy was performed, which revealed subepidermal pustules and perifollicular neutrophilic infiltration (Panel C, hematoxylin and eosin staining). Gram’s stain, periodic acid–Schiff stain, and Grocott methenamine silver stain were all negative. A diagnosis of atopic eruption of pregnancy was made. Atopic eruption of pregnancy is the most common dermatosis of pregnancy. It includes eczema, prurigo, and as seen in this case, pruritic folliculitis. Atopic eruption of pregnancy is typically associated with a history of atopy, which this patient did not have. The condition does not incur risk to the fetus. Owing to the patient’s severe pruritus, cyclosporine and a higher dose of oral glucocorticoid were prescribed. At 2 weeks of follow-up, the lesions had abated (Panel D shows the left arm).