To be pregnant is to be vitally alive, thoroughly human, and distressingly inhabited. Soul and spirit are stretched- along with body – making pregnancy a time of transition, growth, and profound beginnings.
– Anne Buchanan
Pregnancy is one of the most challenging, and yet also rewarding, experience for every woman. Although dermatoses in pregnancy is commonly seen in the clinic, some dermatologist still find it difficult to distinguish between these different diseases. In relation to this, the Dermatopathology Society of the Philippines in cooperation with the Department of Dermatology of the Jose R. Reyes Memorial Medical Center (JRRMMC) presented the monthly continuing medical education (CME) entitled “Skin Lumps on Baby Bumps” last Sept. 25, 2019, 12pm at the Dr. Enrique M. Garcia Auditorium of the Lung Center of the Philippines, Quezon City. This event is hosted by Dr. Elisa Rae Coo-Tan, MD, DPDS and moderated by Dr. Melanie Joy Doria-Ruiz, MD, DPDS.
The event, attended by approximately 180 live and webinar participants, started with an industry-sponsored lecture entitled ABCs of Topical Therapy in Atopic Dermatitis by Dr. Ma. Angela M. Lavadia, MD, FPDS and Dr. Cinday Jao-Tan, MD, FPDS and thereafter was formally opened by the chairman of JRRMMC Department of Dermatology – Dr. Ma. Flordeliz Abad-Casintahan, MD, FPDS.
This CME is divided into three parts: Part I – Common Dermatoses in Pregnancy, Part II – Psoriasis in Pregnancy and Part III – Ethics.
Part I included a clinical case on atopic eruption of pregnancy by Dr. Kei George J. Rebolledo, MD. Afterwhich. the diagnosis and management of common dermatoses in pregnancy was discussed comprehensively and systematically by the reactor, Dr. Sharmaine Sun, MD, FPDS.
Part II included a case of pregnant psoriasis patient treated with NB-UVB presented by Dr. Mark A. Casintahan, MD, followed by a case of a pregnanct psoriasis patient treated with Ustekinumab presented by Dr. Rosary Judielle S. Gucaban, MD. This was followed by a comprehensive discussion on the possible adverse effects of treatment for psoriasis in pregnancy by Dr. Kara Melissa T. Torres, MD, FPDS.
The series of afternoon lectures was ended a lecture entitled Ethical issues in pregnancy and dermatology by Dr. Jaime P. Nunez, MD, FPDS. This event would not be complete without the guidance and support of the PDS President – Dr. Ma. Purita Paz-Lao, MD, FPDS who closed this month’s CME.
PEARLS THAT THE AUDIENCE DERIVED FROM THE CME:
- Atopic eruption of pregnancy is the most common among the various dermatoses in pregnancy. It is of two major types: P-type and E-type. The E-type is more common and presents as eczematous plaques and excoriated papules on the face, neck, and flexural areas. The P-type presents as follicular papules and pustules on abdomen, then trunk & extremities.
- Management of atopic eruption of pregnancy includes emollients, topical corticosteroids, and antihistamines. A risk-benefit ratio analysis should always be done.
- Biologics appear to be safe in pregnancy. However, because they are relatively new in the field, no general consensus statement can be said regarding the safety of biologics in pregnancy.
- Safe treatment options for pregnant patients with psoriasis include: NB-UVB, emollients, topical corticosteroids, and dithranol. Methotrexate and cyclosporine are absolutely contraindicated.
- Ethical dilemmas related to aesthetic procedures during pregnancy reflect a conflict between the woman’s autonomy and physician’s judgment of that is best for the fetus. The well-being of the fetus and the moral obligaiton of no harm takes priority over the cosmetic needs of the patient.