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Three Cases of Hyperpigmentation of Pregnancy

Three Cases of Hyperpigmentation of Pregnancy

Some degree of hyperpigmentation develops in most pregnant women. This coloration is more pronounced in dark-skinned women; on naturally pigmented areas, such as the areolae, perineum, and umbilicus; and on the axillae, inner thighs, and other regions that are prone to friction. The exact cause of physiologic hyperpigmentation is not known. Melanocyte-stimulating hormone levels are markedly elevated during pregnancy. Estrogen and progesterone reportedly have melanocytestimulating effects. In pregnancy, hypertrophy of the intermediate lobe of the pituitary gland occurs with increased metabolism of proopiomelanocortin to μmelanotropin. Oral contraceptives may produce similar cutaneous changes. Hyperpigmentation in a black woman. The abdomen of a 25-yearold African American woman in the third trimester of pregnancy showed linea nigra, intense linear hyperpigmentation from the symphysis pubis to the umbilicus (Figure 5). Less pronounced hyperpigmentation was noted from the umbilicus to the xiphoid process; numerous striae also were seen. Dark pigmentation in a white woman.Increasing pigmentation of the umbilicus began in the first trimester of a 34-year-old woman's pregnancy. The area continued to darken until term (Figure 6). The fine scar that bisects the patient's umbilicus resulted from a previous laparoscopy. Chloasma. The "mask of pregnancy," or chloasma or melasma gravidarum, is seen on a 28-year-old woman who was 2 years postpartum (Figure 7). The patient was gravida 5, para 3, aborta 2; her last child was delivered by cesarean section because of a breech presentation. After delivery, the patient received 2 injections of medroxyprogesterone, 150 mg, 3 months apart. The discoloration developed initially during the fifth month of her pregnancy; it intensified throughout the remainder of gestation and has remained unchanged since delivery. Exposure to sun temporarily heightens the coloration. The patient has not taken oral contraceptives or hormones other than the medroxyprogesterone injections since delivery. In most women, the hyperpigmentation regresses markedly or disappears completely after delivery. A hydroquinone cream can be used to bleach or lighten the discoloration. (Cases and photographs courtesy of Dr Robert P. Blereau.)

References

REFERENCES:
1. Shornick JK, Meek TJ, Nesbitt LT Jr, Gilliam JN. Herpes gestationis in blacks. Arch Dermatol. 1984; 120:511-513.
2. Winton GB, Lewis CW. Dermatoses in pregnancy. J Am Acad Dermatol. 1982;6:977-998.
3. Kolodny RC. Herpes gestationis. A new assessment of incidence, diagnosis, and fetal prognosis. Am J Obstet Gynecol. 1969;104:39-45.
4. Holmes RC, Black MM. The fetal prognosis in pemphigoid gestationis (herpes gestationis). Br J Dermatol. 1984;110:67-72.
5. Shornick JK. Herpes gestationis. J Am Acad Dermatol. 1987;17:539-556.
 
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