PRURITUS IN PREGNANCY

Itching is a common complaint in pregnancy, occurring in up to 14 to 23 of women. Pruritus may be so severe that it affects sleep and quality of life. It has a prevalence of 0.7 to 5% in different populations.  Genetic and environmental factors and varies between populations worldwide.

CAUSES

Systemic Causes of Pruritus:

Pruritus can be an important dermatologic clue to the presence of significant underlying pathology in 10 to 50% of adults. Systemic causes must be considered, in whom pruritus is persistent and refractory to management.

• Systemic causes of pruritus
• Uremia
• Cholestasis
• Polycythemia vera
• Hodgkin’s lymphoma
• Hyperthyroidism chronic renal failure
• Cutaneous T-cell lymphoma
• Human immunodeficiency virus (HIV) infection
• Herpes zoster prodrome.

CLINICAL PRESENTATION:

Obstetric cholestasis typically presents with sudden onset of severe pruritus that may start on palms and soles but quickly becomes generalized. It persists throughout pregnancy and may be worse at night. To start with the skin usually is completely unaffected; later-on scratching leads to, secondary skin lesions ranging from slight excoriations to severe prurigo nodules. The skin should be inspected and dermatographia artefacta (skin trauma from intense scratching), which may be seen in OC should be differentiated from other common skin conditions such as eczema or atopic eruption of pregnancy (previously referred to as eczema of pregnancy, prurigo and pruritic folliculitis) should be done. If a rash is present, polymorphic eruption of pregnancy or pemphigoid gestations (blisters) should be considered. Skin lesions usually involve the extensor surfaces of the extremities, but may also affect other sites of the body such as buttocks and the abdomen. Pale stools and dark urine should be looked for. Jaundice, due to concomitant extrahepatic cholestasis, occurs in about 10% of patients, usually after 2 to 4 weeks, complicating the most severe and prolonged episodes. Steatorrhea may lead to the development of cholelithiasis.

Prognosis:

The prognosis for the mother is generally good. After delivery, pruritus disappears spontaneously within days to weeks but may recur with subsequent pregnancies and oral contraception.

HOMOEOPATHIC TREATMENT

MEDORRHINUM: It is one of the most useful medicine in the treatment of pruritus in pregnant women. There is intense and incessant itching of skin which get worse at night and when thinking of it.

ICTHYOLUM: It is another top grade medicine which is used in  the treatment of pruritus of pregnancy. Here, the skin is burning with irritation and itching.

HELONIAS DIOICA: The pregnant women suffers from pruritus vulvae. There is also albuminuria during pregnancy. All the symptoms are better when keeping herself busy.

CYCLAMEN EUROPAEUM: This medicine is indicated when digestion is disturbed with very salty salivation. Anaemic and chlorotic condition of the women suffering from pruritus better by scratching.