Prurigo of pregnancy: An appropriate term for cases not associated with atopy

Abstract

Dear Editor, Rudder and colleagues have written an informative review on pruritus in pregnancy that includes a discussion about pregnancyspecific skin conditions such as atopic eruption of pregnancy (AEP). AEP, an umbrella entity based on atopic background in women, comprises eczema in pregnancy, prurigo of pregnancy (PP), and pruritic folliculitis of pregnancy. Nevertheless, several aspects of AEP have been challenged, including the use of serum IgE elevation as a diagnostic criterium, which Rudder et al. acknowledge, and the presence of atopy in many PP women. The largest prospective study on pregnancy dermatoses to date did not confirm an association of PP with atopy, and an Indian study found a history of atopy in only 3 of 27 women with PP. My group published recently a series of 20 PP cases that were not associated with atopic background (defined as personal or family history of atopy). The eruption showed typical clinical PP features could persist until delivery, and did not recur postpartum. It started in the late second to early third trimester (median gestational age: 27.5weeks) while AEP has been reported before the third trimester in 75% of women. Comorbidities unrelated to atopy, such as psychiatric disease (20%), were noted in the series. Based on the above, the presence of atopic background has not been confirmed in a significant percentage of PP women. The PP group is likely heterogeneous and multiple etiopathogenetic pathways may be involved. Most importantly, the AEP label to a PP case in a woman without an atopic history may lead to biased counseling about a woman’s genetic predisposition that can give women the impression that they have a genetically determined skin disease. I suggest not labeling as AEP but keeping the term PP for those PP eruptions in women without atopic background.