Clinical Case 1

Clinical presentation A 40-year-old gravida 2, para 1, presented in the 17th week of gestation with severely pruritic (worst pruritus intensity of the previous 24 h on the numerical rating scale: 10/10) papular skin lesions that first appeared during the first pregnancy, with partial remission after delivery and exacerbation within the first week of the second pregnancy. The pruritus was generalized with additional pinprick sensation causing severe impairment of quality of life (Dermatitis Life Quality Index score: 13, ItchyQoL score: 2.9).

Workup On admission, the patient presented with disseminated inflamed papules, scratch excoriations, and scars sparing the face and scalp areas. Both direct immunofluorescence and ELISA were negative, and no relevant abnormalities were found in routine laboratory blood tests. The patient had a positive medical history of allergic rhinoconjunctivitis, allergies to pollens, and positive family history (sister) of atopic eruption in pregnancy.

Treatment and course Based on the clinical presentation, the diagnosis of atopic eruption of pregnancy was made. Treatment included narrowband ultraviolet B phototherapy combined with systemic antihistamines (loratadine 10 mg twice daily), topical glucocorticosteroids (diflucortolone valerate 0.1% cream), and sufficient emollient therapy. This treatment regimen brought some relief of the pruritus (20% improvement).