產檢的常見問題中，妊娠癢疹排在前幾名，有些產婦求診許多醫療院所，問題還是沒有解決。
長期的抓癢會使皮膚破皮，流血，二度細菌感染。患處表皮增厚，苔蘚化，嚴重者會導致失眠，疲憊，憂鬱而影響工作與生活。
妊娠癢疹泛指與懷孕有關的皮膚搔癢，常伴隨孕期結束而病情逐漸消退。好發的高峰期落在懷孕中末期。影響約十分之一的孕婦。
妊娠癢疹在臨床上有許多可能的鑑別診斷 如 多形性癢疹，異位性癢疹，搔癢性毛囊炎，肝內膽汁鬱滯性疹或妊娠水泡疹 (“類天疱瘡疹“）
其中最常見的是多形性癢疹：它的特徵是在妊娠紋上出現搔癢的丘疹及蕁麻疹狀皮膚斑。約一半的初產婦會從腹部擴展至胸部及背部，沒有波及到臉部及肚臍。通常不會發生在手或腳的末端。我們通常都會給予局部藥膏治療。
雖然大部分與妊娠有關的癢疹對母體及胎兒無影響，但是也有少部分癢疹有潛在的母胎風險，及下一胎孕期復發的可能。如上述分類中的妊娠水泡疹 (“類天疱瘡疹“），它屬於一種罕見的自體免疫性疾病，長全身性水泡，可能生下低體重新生兒，早產或新生兒疱疹性皮膚炎。應及早給皮膚科醫師檢查與治療。還有肝內膽汁鬱滯性疹: 孕婦膽汁酸過高，肝功能異常，血中維他命K濃度低(容易產後大出血)，有可能發生早產或胎兒缺氧，羊水胎便染色，甚至死產或造成新生兒呼吸窘迫症候群。有這樣疑慮的時候會做更多的檢查並可能需要住院觀察與肝膽內科會診。
雖然只是癢，但下次記得告訴您的婦產科醫師，我們願意傾聽任何的”小問題“。
註:皮膚疹的圖片不甚討喜，謹將我認為較有公信力的網站附上，供大家參考。
https://dermnetnz.org/topics/skin-problems-in-pregnancy/
＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝＝
Itchy rash is one of the most common complaints that I see at prenatal clinics. Some women’s itchiness persists despite multiple treatments and doctors’ opinions. Whilst chronic scratching may lead to skin thickening or recurrent infections, itchiness can severely affect the quality of life of mothers by causing insomnia, tiredness and even depression.
Itchy rash of pregnancy most commonly occurs during second to third trimesters, then improves postpartum. It affects about 10% of the pregnant women.
The differential diagnosis of these itchy rashes is broad, including but not limited to polymorphic eruption of pregnancy (its long acronym is “PUPPP” but I won’t bore you with this), atopic eczema, prurigo of pregnancy, cholestatic pruritis and pemphigoid gestationis. Other diagnoses like contact dermatitis or scabies are not uncommon during pregnancy but I consider them as diagnoses not specific to pregnancies.
The ones that i see the most are polymorphic eruption of pregnancy, it is characterised by raised rash of multiple shapes (polymorphic) especially over the striaes on the tummy. In about half of the mothers with first baby the rash will extend to the chest and the back, however, the face and the belly button are often spared. Also it does not affect hands or feet. Treatment is usually topical.
Although most itchy rashes of pregnancy are not serious, some (although rare) can be quite serious that requires close monitoring and consultation with dermatologists or internal medicine physicians. For example, “pemphigoid gestationis” is a rare autoimmune skin disease during pregnancy that causes bullous eruption all over the body. This is due to formation of antibodies against mother’s skin, and sometimes these antibodies can cross the placenta and affect the babies. Another serious skin condition is cholestatic pruritis, it is due to build up of bile salts in the body from abnormal liver function, which can sometimes lead to a myriad of systemic and fetal complications if not treated.
Remember to tell your obstetrician and gynaecologists about your itchiness. We are here to listen to all of your concerns and worries.
