Clinical Case 2

Clinical presentation A 40-year-old woman presented in the 27th week of gestation with generalized pruritus without primary skin lesions, involving palms and soles, which started in the second trimester. This condition was very burdensome for the patient and was causing severe sleep impairment. The patient was initially given topical steroids, anti-scabies treatment, and cetirizine 10 mg once daily in an attempt to relieve her symptoms, without therapeutic effect.

Workup Clinical examination revealed multiple disseminated telangiectasia all over the body, especially at the palms and soles, most probably incidental to the pruritus and due to hormonal changes in pregnancy. Additionally, the whites of the eyes showed a yellowish coloration. The patient had negative personal and family history of atopic conditions and other dermatological disorders. The serum bile acid level was 12.2 μmol/l (reference value 0–6 μmol/l), with only marginally elevated aspartate aminotransferase (37 U/l; reference value 10–35 U/l), serum amylase (107 U/l; reference value 28–100 U/l), and triglycerides (236 mg/dl; reference value < 150 mg/dl).

Treatment and course Based on the clinical picture and laboratory findings, the diagnosis of intrahepatic cholestasis in pregnancy was made. Therapy with ursodeoxycholic acid 500 mg twice daily and loratadine 10 mg twice daily was initiated. Emollients with polidocanol, urea, and menthol were recommended. The patient was lost to follow-up.