Il prurito e le dermatosi durante la gravidanza

Il prurito e le dermatosi durante la gravidanzaÈ un sintomo molto frequente in gravidanza e direi anche un sintomo che può destare grande preoccupazione. Ricordo ancora con un pò d’ansia quando intorno al quarto mese della gravidanza di Supernano ha iniziato a prudermi la pancia; lo raccontai quasi per caso alla ginecologa che invece mi mandò subito a fare gli esami della funzionalità epatica temendo un problema del fegato. Per fortuna era solo la mia pelle già molto sensibile che iniziava a fare “qualche scherzetto”.
Ma quali sono le dermatosi associate alla gravidanza che possono causare prurito?

Eruzione atopica della gravidanza
In genere insorge nel II trimestre ed è caratterizzata da prurito, follicoline pruriginosa o eczema. Due terzi delle pazienti ha alterazioni eczematose diffuse, principalmente agli arti, un terzo ha lesioni focali come follicoliti, papule o pustole. È la dermatosi più comune della gravidanza.

Colestasi intraepatica della gravidanza
Tipica del III trimestre, è caratterizzata da insorgenza improvvisa di intenso prurito spesso al palmo delle mani o alla pianta dei piedi, poi generalizzato. È associata ad alterata funzionalità del fegato. In una percentuale variabile fra il 20 e il 60% è associata a parto prematuro, 20-30% dei casi di stress fetale durante il parto, mentre i danni fetali sono 1-2%. Anche la mamma può andare incontro a complicanze anche emorragiche.

Pemfigoide gestazionale
Nel III trimestre o nel post partum si può sviluppare questa patologia autoimmunitaria in cui l’intenso prurito precede lo sviluppo di placche o papule nell’area ombelicale, che si possono diffondere rapidamente a formare bolle. Può essere responsabile di crescita fetale ridotta.

Eruzione polimorfa della gravidanza
E’ più frequente nelle primipare nella fase tardiva del III trimestre e nel post partum soprattutto in seguito ad aumento ponderale eccessivo della madre a gravidanze multiple. Inizia con delle strie che si uniscono fra loro a formare delle papule o placche pruriginose sulle natiche o sulla parte prossimale delle cosce. In genere si risolve in 4-5 settimane senza esiti né per la mamma né per il bambino.

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