"Baby Bumps": Jennifer Murase, MD, on Dermatoses During Pregnancy

Jennifer Murase, MD, covered topics and pearls related to women’s health in a series of 3 presentations at the 2024 Elevate-Derm West Conference. One of her sessions, titled, “Baby Bumps: Understanding the Dermatoses of Pregnancy,” outlined how to safely and effectively treat the primary dermatoses exhibited or exacerbated during pregnancy.

TRANSCRIPT

Murase: My name is Dr Jenny Murase, and I am the director of medical consultative dermatology at the Palo Alto Foundation Medical Group, and I'm associate clinical professor at UCSF. I just presented at NP Elevate in Arizona over the past few days on 3 presentations related to women's health and dermatology.

Dermatology Times: What did you cover during your session titled, "Baby Bumps: Understanding the Dermatoses of Pregnancy"?

Murase: Now there are 4, it kind of depends if you're a lumper or a splitter, but there are 4 primary dermatoses of pregnancy, that we call the baby bumps right of pregnancy. Then there's 1 that's a little bit more controversial, but it's thought it to be the fifth pregnancy dermatosis. The way that I think about them, I always think about what's causing it, and it helps me to remember what I need to do. The most common would be atopic eruption of pregnancy. I'll draw a little yin yang for my patients, where I have the cell mediated immunity on TH1 side. That's the soldiers of our immune system, fighting bacteria, viruses, and fungus.Then we haveTH2 on the other, the allergic arm of the immune system, estrogen causes a shift so that you become more TH2 and allergic dominant. I remember I was pregnant with my daughter, and I was talking about how you become more allergic, and you get atopic dermatitis more easily in pregnancy, and I was just sneezing like crazy, so allergic at the time. That conditionis by far and away, the most common. Polymorphic eruption of pregnancy, which is when the skin is being stretched. That's why it's going to occur later in pregnancy, and it's going to occur in areas where the skin is stretched, like the abdomen and the thighs, and both those have any implications to the fetus. Then we have extrahepatic cholestasis of pregnancy, and that is a condition that there is a strong genetic component, but there's no primary lesions in the skin. Everything is secondary. Everything is from scratching, and that's related to bile acids being high, and bile acids can affect the placenta. There are implications to the baby. And finally, there is a condition, herpes gestationis, or pemphigoid gestationis - there's 2 names for it. It has nothing to do with the herpes virus, and it's an autoimmune disease where the antibodies will attack the junction between the epidermis and the dermis, because the placenta and the skin are both epidermal in origin. The antibodies that are created that are attacking the skin can also affect the placenta and that could affect the pregnancy. We detect that by doing a biopsy. So when in doubt, you want to do bile acids and a biopsy, because those are the 2 that could have implications. There's also a condition, as I mentioned, this fifth dermatosis, a psoriatic condition. It's called impetigo herpetiformis, even though it has nothing to do with staphylococcus aureus and nothing to do with the herpes virus. That condition is, there is a new agent on the market, spesolimab, that is an IL-36 antagonist that's used for generalized pustular psoriasis of pregnancy. That is a newer therapeutic that can help with this, this, this pustule based rare eruption that occurs in pregnancy.

DT: How can clinicians work together to provide holistic care for new mothers?

Murase: I think that there really has been a paradigm shift over the course of the past 10 to 15 years where we are developing a very patient-centric approach. It's almost like there's a whole care team that's surrounding the patient and providing many, many different facets of care. Whether it's nutritional care or obstetric care or dermatologic care, the specialist, the primary care, and then different forms of nursing that might be required, as well as acupuncturists and herbalists.We're all a team caring for the patient in terms of their particular needs and their desires for how they want to approach their care.When I think of holistic care, I think about how our electronic medical records are making it much easier for us to communicate, and I think that that's1 of the reasons why we can be more effective with this holistic care and be copying each other on the notes more easily and communicating. I know that patients really appreciate it when I'm in the room and I'm calling their doctor, or I'm typing a note to their doctor or their provider, the nurse, whatever it might be, so that they can see that communication is taking place. Then I feel like they feel like they're part of this team, and everyone's talking. I think 1 thing that the providers can do is kind of make that effort to make a point that they're reaching out.It doesn't have to be done later in the day when they don't even know you're communicating, show that you are kind of bringing in the troops and calling in the team and communicating with the team so that they know that they're the center of that team. It's also very important, I think, for all dermatology providers, to have a lactation consultant in the area that they know. Because lactation, the nursing, I should say, is an art. It really is just the exact latch, which is the position of the baby's mouth and head. It's a very subtle art and limiting the trauma to the nipples in our patients with sensitive skin, whether they have atopic dermatitis or psoriasis, because psoriasis can koebnerize, meaning it forms in areas of trauma on the nipple. The nipples need to be in very excellent shape, especially atopic dermatitis, right before delivery, in order to limit pain and lactation, consultants can certainly help you.

[Transcript has been edited for clarity.]