# Clinical Manifestations and Management of Prurigo in Pregnancy: A Systematic Review

## TL;DR

This systematic review explores the symptoms and treatments of prurigo in pregnancy, highlighting the need for standardized approaches due to variability in clinical features and responses.

## Contribution

The study provides a comprehensive and up-to-date assessment of prurigo in pregnancy's clinical manifestations and treatment effectiveness.

## Key findings

- PP typically presents with itchy papulonodules on extremities and is associated with conditions like intrahepatic cholestasis.
- Treatments include topical steroids, emollients, antihistamines, and UVB, with variable effectiveness and recovery times.
- The review emphasizes the need for larger-scale research to standardize diagnosis and treatment approaches for PP.

## Abstract

A particular type of dermatosis known as prurigo of pregnancy (PP) is typified by highly itchy papulonodules that primarily affect the extremities' extensor surfaces and the hand and feet dorsum. Despite PP not being a rare illness, there is surprisingly a distinct lack of studies exploring its depth. Therefore, this study seeks to thoroughly describe the clinical manifestation and treatment of pregnancy-related prurigo. Additionally, it aims to provide a comprehensive and up-to-date assessment of the effectiveness of different approaches to pregnancy prurigo therapy. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The systematic review searched PubMed, EMBASE, Web of Science, and Cochrane databases from the databases' establishment to 13 August 2024. The studies were deemed included if they were randomized controlled trials (RCTs), cohort studies, case-control, cross-sectional, case series, and case reports; if they reported clinical manifestations and treatment for PP; and if they were written in the English language. Studies were excluded if they did not meet the aforementioned inclusion criteria; moreover, they were excluded if they were of high risk of bias or low quality. The articles included were assessed using the Newcastle-Ottawa scale and methodological quality, and the synthesis of non-randomized studies. Four different studies, with a total of 63 patients, were included in our article. The typical rash of PP is described in most patients with variable onset and distribution on the body, from the extremities to the back to the buttocks. PP can be associated with a variety of conditions, including a history of other skin conditions, such as intrahepatic cholestasis and other medical conditions. Different treatments for PP in pregnant women were reported across the included studies, most commonly a combination of topical steroids, emollients, oral antihistamines, oral corticosteroids, and ultraviolet narrow band (UVB). The effectiveness of the various therapies is variable; some patients recover before delivery, while others recover months postpartum. This systematic review emphasizes how complicated PP is in terms of both its clinical manifestations, associations, and management. The evidence points to the urgent need for a more uniform approach to diagnosis and management due to substantial variability in the clinical features, onset, and treatment responses. The study emphasizes the need for additional, larger-scale research using standardized outcome measures to identify characteristics that predict treatment success and allow for more robust comparisons of treatment modalities.