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Background: Pemphigoid gestationis (PG) and polymorphic eruption of pregnancy (PEP) are pregnancy-related dermatoses. Definitive diagnosis often relies upon histopathology and direct immunofluorescence (DIF). PG is associated with fetal and neonatal risks, while PEP confers minimal risk., Objective: We aimed to compare histopathologic features to determine key differentiators., Methods: A retrospective cohort study of PG and PEP cases, with accompanying DIF, conducted from 1995 to 2020. Skin biopsies were examined independently in a blinded fashion by two dermatopathologists for a list of histopathological features., Results: Twenty-one cases of PG and 10 cases of PEP were identified. PG had significantly denser eosinophils than PEP (mean 155 vs. 48 cells/5 hpf; p < 0.018). PG was also noted to have eosinophilic spongiosis and eosinophils at the dermal-epidermal junction more frequently compared to PEP (80% PG vs. 10% PEP; p < 0.001). A mean cutoff value of 86 eosinophils and a mean optimal sensitivity and specificity of 81% and 83%, respectively, for eosinophils density's diagnostic power of PEP versus PG were achieved. Subepithelial separation was exclusively seen in PG (40% vs. 0%; p < 0.007)., Conclusion: Eosinophilic spongiosis, eosinophilic epitheliotropism, and dense superficial dermal eosinophils were diagnostic of PG. Given overlapping clinicopathologic features, however, DIF results with clinicopathologic correlation, remain the gold standard., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Specific dermatoses of pregnancy are skin disorders that occur specifically during or immediately after pregnancy and cannot be found in non-pregnant patients. According to the current consensus, they include atopic eruption of pregnancy (AEP), polymorphic eruption of pregnancy (PEP), pemphigoid gestationis (PG), and intrahepatic cholestasis of pregnancy (ICP). The diagnosis of specific dermatoses of pregnancy can be challenging due to their variation in clinical presentation; moreover, the tests currently available do not always provide the clue for the diagnosis. However, some distinctive features may be helpful to differentiate between such entities. Accordingly, the knowledge of specific dermatoses of pregnancy and of their management is critical, since their early recognition may allow to provide care for the mother and prevent potential increased fetal risk. In fact, while AEP and PEP do not affect maternal and fetal prognosis, PG and, mainly, ICP are associated to maternal complications as well as the risk of fetal loss. In this paper, the epidemiology, pathogenesis, clinical features as well as management of AEP and PEP are reviewed in detail, while PG is described in another article of this issue. Moreover, the main features of ICP, which cannot be considered a primarily skin disease but may be managed first by dermatologists, are reported.

Skin manifestations during pregnancy are common and diversified. This review will focus on the most important entities to be recognized by obstetricians. These are, on the one hand, physiological changes, where unnecessary investigations should be avoided, and on the other, the specific dermatoses of pregnancy. These develop electively in pregnancy, and they are currently grouped into three disorders: polymorphic eruption of pregnancy, atopic eczema of pregnancy, and pemphigoid gestationis. Arguments for recognition of these are presented including detection of anti-BP180 antibodies. Follow-up and treatment depend on the precise diagnosis. Risks in fetal prognosis may occur in rare pemphigoid gestationis cases., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Mid-dermal elastolysis (MDE) is an uncommon and probably underdiagnosed disorder of the elastic tissue. Clinical suspicion and histopathological confirmation are essential for the diagnosis. We report the case of a young woman who presented with this disorder after an inflammatory process during pregnancy and we review the main characteristics of this rare entity.

The pregnancy-specific skin disorders are pruritic, inflammatory eruptions. The current classification by Ambros-Rudolph et al. includes four entities: pemphigoid gestationis (PG), polymorphic eruption of pregnancy (PEP), atopic eruption of pregnancy (AEP), and intrahepatic cholestasis of pregnancy (ICP). Although these disorders are all characterized by intense pruritus during pregnancy, they can be distinguished by timing, morphology, histopathology, treatment and potential for fetal complications. Diagnosis is made by clinical presentation, histology, and immunofluorescence. PEP and AEP typically resolve without sequelae; however, PG may lead to prematurity and low birth weight, and ICP is associated with an increased risk of prematurity, fetal distress, and intrauterine fetal demise. The potential for serious fetal complications necessitates a thorough evaluation of pregnancy-related pruritus. This article will discuss the skin disorders specific to pregnancy, with a focus on clinical presentation, potential for fetal complications, pathogenesis, diagnosis, and treatment.

Family physicians usually follow up pregnancies in which no special incidences are expected to occur. Cutaneous pruritus is a common symptom in pregnant women, on most occasions without further consequences. However, noteworthy is a group of very rare pathologies known as pregnancy dermatoses, some of which may have potentially severe complications, mainly for the fetus and the pregnancy outcome, and also, to a lesser degree, for the mothers and other future pregnancies. It is essential to know how to manage the pruritus, and how to take an adequate clinical history in order to diagnose these severe conditions. The case of a pregnant woman who consulted for pruriginous dermatoses (pemphigoid gestationis) is presented to illustrate this topic. A description of the diagnostic process, differential diagnosis, treatment and outcome, is included., (Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.)

Adult Still disease is an inflammatory arthritis classically associated with daily spiking fevers, evanescent rash, organomegaly, lymphadenopathy, and laboratory anomalies. The typical cutaneous lesions are thin pink papules in a morbilliform distribution, of short duration. Histologically, these lesions are characterized by a superficial perivascular and interstitial mixed dermatitis with lymphocytes and variable neutrophils. A variant clinical presentation is increasingly recognized, which demonstrates persistent hyperpigmented plaques, often with a rippled or linear appearance. The histologic findings consist of upper epidermal dyskeratotic keratinocytes, increased dermal mucin, and a superficial perivascular infiltrate of lymphocytes and possibly neutrophils or eosinophils. We encountered 2 patients who presented with the characteristic rash of adult Still disease, both of whom progressed to develop the pigmented cutaneous plaques. We propose that this variant clinical and histologic appearance is the outcome of persistent disease activity.

What is probably the first description of targetoid or iris lesions, as they appear in erythema multiforme (EM), can be found in Thomas Bateman's 1836 textbook "Practical Synopsis of Cutaneous Diseases According to the Arrangement of Dr. Willan." EM was initially described by Bateman and later by von Hebra as an acute self-limiting skin disease, symmetrically distributed on the extremities with typical concentric "targetoid" or "iris" lesions, and often recurrent. Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) were added to this syndrome later. A newer classification has created two disease spectra: EM consisting of EM minor and EM major (or bullous EM), and SJS and TEN. EM minor and EM major are often recurrent, postinfectious (especially after herpes and mycoplasma) disorders with low morbidity and almost no mortality. SJS and TEN are usually severe drug-induced reactions with high morbidity and poor prognosis. The target lesions found in each form of the disease are described and defined. Although the term "target lesion" originated from the description of EM and despite its being the dominant lesion in this disease, it is not pathognomonic for EM, and these lesions can sometimes appear in other diseases. Short descriptions of these other diseases are presented., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Like all organ systems, the skin undergoes significant changes during pregnancy. The majority of physiologic skin conditions related to gestation resolve after childbirth. However, they may cause significant concern or cosmetic distress or be mistaken for one of the specific dermatoses of pregnancy. Dermatoses unique to pregnancy are rare but important to recognize because they may be intensely pruritic or painful to the mother, and they may pose significant risks to the patient, her fetus, or both. Clinicians familiar with the cutaneous manifestations of pregnancy can most effectively treat and counsel patients, guide expectations, and avoid unnecessary diagnostic tests and therapies. This review summarizes physiologic skin changes in the gravid patient and the specific dermatoses of pregnancy., (© 2011 The International Society of Dermatology.)

Some aspects regarding the etiology and the nosologic classification of various pregnancy dermatoses are highly controversial. While some authors highlight the existence of premises allowing several skin disorders to be re-grouped within broader disease concepts, others underline the absence of clear, undisputed etiopathogenetic data that could support such classifications. This review exhaustively analyzes the various pregnancy dermatoses (pemphigoid gestationis, intrahepatic cholestasis of pregnancy, impetigo herpetiformis, polymorphic eruption of pregnancy, and the papular dermatoses of pregnancy [prurigo of pregnancy, pruritic folliculitis of pregnancy, and the new classification, atopic eruption of pregnancy]) in an attempt to shed light over this confusing and disputed domain, while subsequently offering an algorithmic approach to their diagnosis and management. While for pemphigus gestationis, intrahepatic cholestasis of pregnancy, and impetigo herpetiformis, specific diagnostic tests such as histopathology, immunofluorescence, or laboratory investigations will confirm the diagnosis, the identification of the other types of pregnancy dermatoses is based only on clinical criteria. In this context, the review argues for the inclusion of the whole group represented by the papular dermatoses of pregnancy within the broad spectrum of polymorphic eruption of pregnancy, separating each of these entities by focusing on their onset: early-onset polymorphic eruption of pregnancy (comprising prurigo of pregnancy, pruritic folliculitis of pregnancy, and atopic eruption of pregnancy) and late-onset polymorphic eruption of pregnancy. In light of the same practical approach guiding it, the review provides updated treatment strategies for each of these conditions.

Acquired perforating collagenosis (APC) is a rare condition in which altered collagen and elastin fibres undergo transepidermal elimination. The pathogenesis is unknown but it is usually associated with underlying systemic disease, most commonly diabetes mellitus and renal impairment. We describe a case of an acquired perforating disorder occurring in pregnancy. APC is a diagnosis that can easily be missed, especially in atypical cases such as ours, and clinicians and histopathologists need to be aware of this condition to avoid unnecessary patient morbidity.

Background: Stretch marks or striae distensae (SD) can be considered a common skin disorder, but their physiopathogenic mechanisms have not been totally clarified. Although it is considered an esthetic complaint, it may have serious psychosocial consequences besides the local and systemic alterations of the conjunctive tissue. This study aims at assessing and quantifying the estrogen, androgen and glucocorticoid receptors in skin samples with striae and comparing with normal skin., Methods: Skin samples for biopsy were obtained from eight patients with SD and eight patients without lesions. The samples were frozen at -80 degrees C and underwent processing to obtain proteic extract to quantify the estrogen, androgen and glucocorticoid receptors with the Western Blot method., Results: When the estrogen receptor in the skin with SD was compared with healthy skin, it was observed to have increased twice as much (P = 0.00001). The androgen and glucocorticoid receptors in the SD skin had also increased (P = 0.00015 and P = 0.00083, respectively)., Conclusions: These findings indicate that under certain conditions there is an increase in hormonal receptor expression, suggesting that regions that undergo greater mechanical stretching of the skin may express greater hormonal receptor activity. This activity may influence the metabolism of the extracellular matrix, causing the formation of SD. Alterations in hormone receptors occur within a well-defined time period during the formation of SD; however, there are differences in the functionality of hormone receptors during different stages in the development of the lesions. The preliminary results appear to be relevant and represent an initial step towards an understanding of the pathophysiology of SD.

The specific dermatoses of pregnancy are a rare group of skin diseases specifically related to pregnancy. Diagnostic clues are outlined in a diagrammatic way that can facilitate the recognition between dermatoses of pregnancy in daily dermatology clinic practice.

Pyogenic granuloma, also known as lobular capillary hemangioma, is a benign vascular tumor of the skin and mucous membranes. Whereas the literature describes pyogenic granulomas of pregnancy as occurring mainly within the gingival or oral mucosa, we present 5 cases of a histologically confirmed pyogenic granuloma on the hands of gravid women, each with no history of antecedent trauma. These tumors failed to resolve spontaneously postpartum necessitating surgical removal. We propose the term epulis gravidarum manum to describe this skin lesion.

Verrucose epidermal nevus is a benign and congenital hyperplasia of the superficial epidermis and annexes. It expresses itself during the firs year of life, grows during childhood and in adolescence reaches its largest size. It can appear everywhere in skin surface. We present a case of late verrucose epidermal nevus with genital onset. Differential diagnosis was done with acuminated condylomas.

Dermatoses related to pregnancy or the postpartum period are known as the specific dermatoses of pregnancy. These dermatoses include (a) pemphigoid gestationis (synonym: herpes gestationis), (b) polymorphic eruption of pregnancy (synonym: pruritic urticarial papules and plaques of pregnancy; PUPPP), (c) prurigo of pregnancy and (d) pruritic folliculitis of pregnancy. Of these disorders, only pemphigoid gestationis has a known cause: an allogeneic immune reaction of the mother to the placental basal membrane. Itching or an itchy skin eruption is often the main symptom ofa dermatosis of pregnancy. During the diagnostic process, the possibility of a pre-existing or de novo skin disorder unrelated to the pregnancy should be considered. Correct diagnosis is important for the choice of treatment and for the prognosis of mother and child, because some dermatoses of pregnancy, such as pemphigoid gestationis, constitute a health risk.

Associated with pregnancy skin changes appear at approximately 90% pregnant. For the necessity of proper and complex care of the pregnant woman. The actualization of this knowledge among the family doctors and the obstetricians is crucial. The ability of precise diagnosis of physiological skin changes allows specifying the suspected cases of pathologic etiology and referring them to the dermatological referral centers for in-depth diagnosis and eventual treatment. The physiologic changes of skin appendies were discussed in the presented paper, vascular alterations color, as well as the generative alterations and the changes in the skin.

Collagenomas are considered to be connective tissue nevi composed predominantly of collagen. Collagenomas have been classified into 4 different entities: familial cutaneous collagenoma, the Shagreen patch of tuberous sclerosis, eruptive collagenoma, and other isolated collagenomas. We describe a patient with multiple collagenomas that appeared and multiplied during gestation and discuss the reported cases of collagenomas that have been linked to pregnancy.

To our knowledge, this is the first case reported in the literature of umbilical endometriosis in a pregnant woman. We report a case of umbilical endometriosis in a pregnant woman at 16 weeks of gestation. The patient revealed a reddish-brown polypoid nodule within the umbilical depression, with the typical history of monthly bleeding from the umbilicus. A nodule biopsy, testing of serum levels of CA-125 and a transabdominal ultrasound examination were performed. The diagnosis of endometriosis was confirmed by pathological examination. Serum levels of CA-125 were slightly increased and the pelvic ultrasound examination did not identify ovarian cysts of a possible endometriotic nature. The patient was also examined at 24 weeks' gestation, after delivery and in the late postpartum period. No therapy was given and the lesion resolved spontaneously 2 months after the biopsy was taken.

Lobular capillary hemangioma, which is also named as pyogenic granuloma, is a common vascular proliferation of skin and mucous membranes. Hormonal influence in the development of lobular capillary hemangioma on the mucosal surfaces has been demonstrated but for cutaneous lesions located on the skin, this association has not been shown yet. In this report, a 25-year-old female patient with cutaneous lobular capillary hemangioma of the cheek induced by pregnancy is presented. The lesion was excised and lobular capillary hemangioma was given as diagnosis by histopathological evaluation. Estrogen receptor was weakly positive by immunohistochemical analysis. We suggest that elevated levels of estrogens during pregnancy may have an important role also on the development of cutaneous lobular capillary hemangiomas by direct hormonal action.

Background: Physiologic skin changes are common during pregnancy due to a temporary shift in hormonal, metabolic, and immunologic factors. Physicians may mistake normal skin changes in pregnancy as pathologic change within the skin, and so an appreciation of the common and less common skin manifestations will assist in appropriate patient care., Objective: This review highlights the normal physiologic skin changes in pregnancy, which include pigmentary changes, changes to the hair and nails, alterations in glandular activity, vascular and hematological changes, cutaneous tumors, and mucous membrane changes., Conclusion: Physiologic changes to the skin in pregnancy can be complex and confusing. Pregnancy can be a stressful time for women so it is imperative that physicians be aware of the normal skin changes during pregnancy in order to prevent unnecessary investigations and treatments.

We report the first case of acquired dermal melanocytosis (ADM) appearing during pregnancy. A 23-year-old Hispanic woman presented to the Dermatology Clinic of Columbia-Presbyterian Medical Center during the second trimester of pregnancy with a nonpalpable blue-gray patch with interspersed discrete brown macules on the right lower extremity. It had appeared during the first trimester of pregnancy. Cutaneous biopsy specimens revealed dermal melanocytes. A review of all reported cases of this rare dermatosis in the international literature is presented.

The dermatoses of pregnancy can be classified into the following 3 groups: physiologic skin changes in pregnancy, dermatoses and cutaneous tumors affected by pregnancy, and specific dermatoses of pregnancy. Correct diagnosis and classification are essential for the treatment of these disorders, when necessary. Laboratory investigations are required when the diagnosis remains in question despite a careful history and thorough physical examination. A discussion with the pregnant woman about the nature of her skin condition, and the possible fetal risks associated with it, is imperative.

How do dermatologists examine a patient and instantly generate a differential diagnosis? Of course, as in any other field, experience plays a large role. After a condition with a distinctive appearance is seen hundreds of times, recognition becomes automatic. Nevertheless, dermatologists need to employ a disciplined mental process to generate a differential diagnosis from clinical findings. From the perspective of clinical diagnosis, all dermatology falls into 2 separate categories--inflammatory and neoplastic. The reaction pattern technique discussed in this article relates only to inflammatory conditions such as psoriasis, eczema, and urticaria. This article describes an approach to differential dermatologic diagnosis based on clinical reaction patterns.

Background: Lobular capillary hemangiomas (pyogenic granulomas) occur on both mucosal and cutaneous surfaces. There are conflicting data regarding the increased prevalence of lobular capillary hemangiomas in female versus male subjects. Some studies have noted a female predominance of lobular capillary hemangiomas, but other studies do not reveal such a disparity. Because of an increased prevalence during pregnancy, oral tumors are also known as "granuloma gravidarum" or "pregnancy tumors." A hormonal influence for these mucosal lesions has been postulated. There are, however, no studies that address a possible relationship between hormones and cutaneous lesions., Objective: This study presents the epidemiology of lobular capillary hemangiomas, with an emphasis on cutaneous lesions., Methods: We reviewed 63,759 dermatopathology reports from a regional, private dermatopathology laboratory and found 325 cases of lobular capillary hemangiomas over a 1-year period., Results: In our study of lobular capillary hemangiomas, cutaneous lesions accounted for 86%, with mucosal lesions representing only 12% of cases. Seven cases were excluded (one was intravascular, two were subcutaneous, and in 4 the location was not specified). Overall, male patients outnumbered female patients. The peak incidence for cutaneous lobular capillary hemangiomas was found in the second decade of life. The most common cutaneous sites were the trunk, upper extremities, and head. Mucosal lesions were primarily seen on the lips, gingiva, and tongue, and these affected females more than males by a ratio of 2:1, most commonly in the fourth decade of life., Conclusion: Cutaneous lobular capillary hemangiomas were equally prevalent in male and female patients. This would refute a female hormonal influence in the induction of cutaneous lobular capillary hemangiomas. Our data may suggest a hormonal influence on mucosal lesions because mucosal lobular capillary hemangiomas were twice as common in female patients. However, the small number of lesions in our study precludes us from making such a conclusion.

Awareness of pregnancy-related skin changes can facilitate improved care of women during pregnancy by identifying those skin changes that require further evaluation. Women experience significant endocrine and metabolic changes during pregnancy that can cause both physiologic and pathologic alterations in the skin, nails, and hair. This review discusses the physiologic changes and pruritic dermatoses that are specifically associated with pregnancy. The effect of pregnancy on preexisting skin diseases and safe treatment options for usage during pregnancy will be provided.

In 1994 we set up a specialist clinic for pregnancy dermatoses, both to improve the management of pregnant women with skin problems and to enhance our general understanding of the pregnancy dermatoses. This clinic has provided a large database of 200 women which has formed the basis for a prospective study over a 2-year period. In each case the dermatological diagnosis was clearly defined on clinical criteria, with additional help from histopathology and direct immunofluorescence of the skin where appropriate. We have included a number of patients who presented with relatively trivial diagnoses, as this reflects the referral patterns of our midwives, general practitioners and obstetricians within our hospital and local population. Our results show that all patients with specific dermatoses of pregnancy conformed well to the classification established by Holmes and Black in 1983. The role of the sex hormones [oestradiol, human chorionic gonadotrophin (hCG) and cortisol] in polymorphic eruption (PEP) and prurigo of pregnancy was studied in 125 cases and compared with 138 normal healthy pregnant controls. For pruritic folliculitis (PF), serum androgens were measured to establish if these were elevated. Nearly all patients were followed up postpartum, with respect to both maternal and fetal prognosis (some were unfortunately lost to follow-up). Many patients were primiparous (47%) and presented in their third trimester (49%). This study shows a surprisingly high prevalence of eczema during pregnancy. It is possible that earlier cases in the literature termed prurigo of pregnancy may in fact have been eczema, thus explaining the low incidence of prurigo in this study. Hormonal analysis showed a significant reduction in serum cortisol levels in patients with PEP compared with normal pregnant controls (P = 0.03), although hCG and oestradiol showed no differences. Serum androgens were not significantly elevated in patients with PF compared with controls. Birthweight (analysed by the individualized birthweight ratio) was significantly reduced in both the PF and pemphigoid gestationis groups. In the PEP and PF groups there was a male/female infant ratio of 2 : 1, not noted in previous studies. In all cases studied there were no adverse effects either on maternal or fetal outcome as a result of the pregnancy dermatosis. This study indicates that all patients fulfilled the criteria of the previous classification of the specific dermatoses of pregnancy, although we also now highlight the frequency of eczema in pregnancy and speculate as to possible causes. There were no cases of papular dermatitis of pregnancy. We feel that the specialist clinic is an important service which has improved the management of these women and identified areas for further research.

In the past, very similar and illogical names have been used for some of the dermatoses experienced during pregnancy, a situation which has confused diagnosis. The author suggests a simple classification where the dermatoses are organised into four groups: Pemfigoid Gestationis, Polymorphic Eruption of Pregnancy, Prurigo of Pregnancy and Pruritic Folliculitis of Pregnancy. The overview contains a brief description of the etiology, clinical signs, histology, prognosis and therapy for each type of dermatosis.

We report the case of a 22-year-old woman presenting with the unilateral naevoid telangiectasia syndrome in her third pregnancy. The development of this is well documented but the occurrence in a third pregnancy is unusual. A brief review of the literature is included.

A case of umbilical endometriosis is presented to highlight the challenges in its diagnosis. The etiology, clinical findings, histologic evaluation, prognosis and treatment options are discussed. While cyclic symptomatology may lend evidence to the diagnosis of umbilical endometriosis, history and clinical findings are often equivocal. Decidualization of umbilical endometriosis can be initially confused with a malignant process on histologic evaluation. The potential for malignant degeneration appears low. Surgical intervention is the treatment of choice.

A case of a solitary reticulohistiocytoma during pregnancy is reported. The tumor arose on the right thigh of a 31-year-old woman during the 2nd month of gestation. Physical examination 6 months later revealed a 9 x 6 mm yellowish white papule. A biopsy showed a dermal proliferation of spindle to polygonal cells embedded in fibrous tissue with admixed neutrophils, eosinophils, and lymphocytes. Immunohistochemistry was positive for S-100, factor XIIIa, HLA-DR, KP-1, vimentin, and neuron-specific enolase. Ultrastructurally, the cells showed abundant lipid, lysozomes, and endoplasmic reticulum. No Birbeck granules could be identified. The results suggest an aberrant immunophenotype intermediate between indeterminate cells and dermal dendritic cells. The relationship of these lineages to reticulohistiocytoma and other dermal proliferative disorders is reviewed.

We report on a patient with a pustular eruption of the striae in an otherwise normal first pregnancy. The clinical, histologic, and immunologic findings are reviewed and found to be inconsistent with pruritic urticarial papules and plaques of pregnancy and with the three previously described pustular eruptions of pregnancy (impetigo herpetiformis, pruritic folliculitis of pregnancy, and autoimmune progesterone dermatitis of pregnancy). Therefore, we regard this case as unique.

PUPP is a specific eruptive dermatosis in pregnancy, clinically characterized by erythematous papules and plaques with intense itching in periumbilical localization. This disease typically tends to spread to the extremities without involving the head and neck regions. The differential diagnosis of PUPP can be established by immunological and microscopical investigations. Since PUPP is a benign disease with a good prognosis and spontaneous clearing, we recommend only mild symptomatic treatment.

Skin disorders are often associated with pregnancy. Most of these disorders are physiologic but some are pathologic. The following review focuses on skin diseases that are unique to pregnancy.

Pregnancy is a period of profound endocrine and metabolic changes which are tolerated by the body for a relatively short time. During gestation both physiologic and pathologic changes can occur in the skin, nails, and hair shafts which should be recognized and appropriately managed by the dermatologist. These changes can conveniently be placed into five broad categories: (1) physiologic changes in skin and appendages caused principally by the hormonal milieu, (2) cutaneous tumors affected by pregnancy, (3) diseases specifically associated with pregnancy, (4) genital infections of perinatal importance, and (5) other dermatologic diseases influenced by pregnancy. A discussion of each of these topics reveals the vast spectrum of dermatologic disease seen in pregnancy and underscores the important role of the dermatologist in the care of pregnant patients.

This article provides a practical approach to those dermatologic disorders in which an immunologic mechanism is involved in the pathophysiology. There is a brief discussion of evaluation and management for many of these disorders.

The microscopic findings in 31 biopsies of patients with polymorphic eruption of pregnancy are reported with a literature review. Cutaneous changes include edema, dermal lympho-histiocytic infiltrate and epidermal lesions. We have found a correlation between the intensity of the inflammatory response and the presence of epidermal involvement. In our opinion, the histopathological changes may allow an accurate diagnosis with the adequate clinical information. Direct immunofluorescence did not reveal immunoglobulin or complement deposits in the ten cases studied. It may help in the differential diagnosis with nonbullous herpes gestationis.

The principle of immunoelectronmicroscopic studies using horseradish perpoxidase is described. This method, especially the peroxidase-antiperoxidase multistep technique, reveals more details about the exact localization of immunophenomena in different dermatological diseases. The results of immunological investigations performed on the ultra-structural level in bullous diseases, lupus erythermatosus, vasculitis, and psoriasis are summarized and compared with the immunofluorescent and classical electromicroscopic findings.