Version May 2024
| Atopic eruption of pregnancy | Polymorphic eruption of pregnancy | Pemphigoid gestationis | Intrahepatic cholestasis of pregnancy | |
| Time of onset | 75% of cases before third trimester. | Last weeks of pregnancy or immediately postpartum. | Last trimester or postpartum. | Late pregnancy. |
| Pregnancy | Not relevant. | First. | Not relevant. | Not relevant. |
| Clinical features | 20% of patients suffer from an exacerbation of pre-existing atopic dermatitis with a typical clinical picture. 80% will experience atopic skin changes for the first time ever or after a long remission (ie, after childhood eczema), with two main features: (1) E-type: Widespread, eczematous changes affecting typical atopic sites, such as face, neck, upper chest, and the flexural surfaces of the extremities; and (2) P-type: Small, erythematous P-type disseminated on trunk and limbs and typical prurigo nodules, mostly located on the shins and arms. | Urticarial papules and plaques arise from striae distensae usually on the abdomen, characteristically sparing the umbilical region. After 1 or 2 days, the lesions also spread to the thighs and the buttocks and may become frankly polymorphous, showing vesicles (but never blisters), a nonurticated erythema, targetoid lesion, and E-type. | Urticarial papules and plaques with usually tense blisters with typical periumbilical involvement and spreading to the trunk and the extremities. | Pruritus and exclusively secondary skin lesions (excoriations, prurigo). Total serum bile acid levels >11 mmol/L. |
| Diagnostic tests | None required. | None required. | Biopsy for histology and DIF and/or serum ELISA for BP180 antibodies. | Total bile acids; liver function tests; consider hepatitis serology. |
| Maternal prognosis | Unimpaired; common development of nipple and hand eczema after delivery. | Unimpaired. | Exacerbations and remissions during pregnancy, flare-up in 75% after delivery, with resolution within weeks to months. May recur with menstruation and hormonal contraception. | Risk for gallstones and intra/postpartum hemorrhage. |
| Recurrence in subsequent pregnancies | Yes. | No. | Yes, often with earlier onset and more severe course. | Yes. |
| Fetal prognosis | Unaffected, but there is a higher risk of developing atopic skin changes later on. | Unaffected. No cutaneous involvement of the newborn. | Increase for small-for-date and premature babies. 10% of newborns develop mild skin lesions that resolve spontaneously within days to weeks. | Increased risk of prematurity (19 to 60%), intrapartal fetal distress (22 to 33%), and stillbirths (1 to 2%). |
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