Gebeliğe Özgü Dermatozlar
Özet
Gebelik; endokrin, immünolojik, metabolik ve vasküler sistemlerde belirgin değişikliklerin yaşandığı dinamik bir fizyolojik süreç olup gebelerin %90'ından fazlasında gebelik boyunca en az bir dermatolojik değişiklik gelişmektedir. Bu dermatolojik değişiklikler fizyolojik olabileceği gibi maternal semptomların ötesinde fetal prognozu da etkileyebilen gebeliğe özgü dermatozlar ile kendisini gösterebilir. Gebeliğe özgü dermatozlar gebelerde yaklaşık %5–10 oranında izlenmekte ve çoğunlukla benign seyirli olup doğum sonrası spontan gerileme eğilimindedir. Buna rağmen gebeliğe özgü dermatozlar yaşam kalitesini genellikle olumsuz etkilemekte ve bazı alt tipleri fetal prognoz açısından belirgin risk taşımaktadır. Bu bölümde gebeliğe özgü dermatozlar yaygın kabul gören Ambros-Rudolph sınıflamasına göre dört ana antite altında incelenmektedir: en sık görülen ve genellikle ilk iki trimesterde başlayan gebeliğin atopik erüpsiyonu; çoğunlukla üçüncü trimesterde abdominal strialar üzerinden başlayan gebeliğin polimorfik erüpsiyonu; prematürite, gestasyonel yaşa göre küçük bebek doğumu ve neonatal pemfigoid riski taşıyan nadir bir otoimmün büllöz hastalık olan pemfigoid gestasyones; maternal seyri genellikle benign olmakla birlikte ciddi fetal komplikasyonlara yol açabilen, kaşıntı ve serum safra asidi yüksekliği ile karakterize gebeliğin intrahepatik kolestazı. Her bir dermatoz; tanım, epidemiyoloji, etiyopatogenez, klinik özellikler, tanı, ayırıcı tanı ve güncel tedavi yaklaşımları başlıkları altında ele alınarak güncel bir klinik bakış açısı sunulmuştur.
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