Later polymorphic featuresPapulo-urticarial or bullous rash on abdomen with periumbilical involvement
Palms and solesLaboratory testsElevated total serum IgE (20–70%)
Direct immunofluorescence (DIF) negativeDIF negativeDIF positive
Indirect immunofluorescence may be positiveComplicationsMaternal discomfortMaternal discomfortPostpartum flare
Neonatal lesions
Small-for-dates infantTreatmentEmollients
Topical corticosteroids
Oral antihistaminesEmollients
Topical corticosteroids
Oral antihistaminesEmollients
Oral antihistamines
Topical corticosteroids
Systemic corticosteroids
Plasmapheresis
Immunosuppressive therapy

Eczema is a chronic itchy dermatitis affecting up to 10% of the adult population. It characteristically involves flexural surfaces, such as behind the knee or in the elbow crease, but may be generalized. Affected individuals often have dry skin and a personal or family history of atopic illnesses. Complications include infection, sleep disturbance due to itching, and social or psychological problems. More than half of women experience exacerbations during pregnancy.

Women developing new atopic skin changes often have a family history of atopy. They may have typical patchy eczematous changes or papular lesions. Skin dryness is common. Total serum IgE is elevated in 20–70% of women. Normal serum bile acids help differentiate between AEP and obstetric cholestasis.^1,2

Women should be advised to apply an emollient at least 3–4 times a day, and may also use it in the shower or bath; additives such as urea and menthol are considered to be safe.

Topical corticosteroids are considered to be safe in pregnancy, but should be used at the lowest possible potency for the shortest time necessary to control symptoms.

Oral antihistamines, such as chlorphenamine, may be used intermittently to help reduce itching and scratching, particularly at night. Secondary bacterial infections should be managed with systemic or topical antibiotics.

Systemic corticosteroids, such as prednisolone, do not cause concern if used for a few days for an acute exacerbation. Longer-term corticosteroid use or immunosuppressive agents such as ciclosporin or azathioprine should be avoided if possible but may be necessary in severe cases.^1,3

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