Pigmentation and pregnancy: knowing what is normal. Bieber AK, Martires KJ, Stein JA, Grant-Kels JM, Driscoll MS, Pomeranz MK.Vora RV, Gupta R, Mehta MJ, Chaudhari AH, Pilani AP, Patel N.Dermatological manifestations associated with pregnancy. Soutou B, Régnier S, Nassar D, Parant O, Khosrotehrani K, Aractingi S.It can reappear with subsequent pregnancies. Linea nigra usually gradually fades over time after delivery, but some women may have persistent hyperpigmentation. Bleaching has been used in some cases, with unsatisfactory results. Folic acid can be found in foods such as leafy green vegetables, oranges and whole wheat bread. It has been suggested that folic acid reduces the formation of linea nigra. Affected women should avoid sun exposure to the abdomen, as this might cause the line to become darker. Women can be reassured that linea nigra has no adverse effect on pregnancy outcomes, and medical treatment is not required. There is no specific medical treatment for linea nigra. Previous or current superficial skin infections, such as pityriasis versicolor and erythrasma.Pigmented skin lesions, such as melanocytic naevi (moles), seborrhoeic keratoses, and lentigines.Flagellate hyperpigmentation associated with exposure to bleomycin, peplomycin, and docetaxel dermatomyositis adult-onset Still disease and Shiitake mushroom dermatitis.Other pigmented conditions that may occur on the abdomen include: Occasionally, other forms of localised hyperpigmentation may be considered in the differential diagnosis of linea nigra. What is the differential diagnosis for linea nigra? Like other cutaneous physiological changes of pregnancy, linea nigra is diagnosed clinically. It is often accompanied by the 'ligamentum teres sign', when the umbilicus deviates to the right.Linea nigra can increase in width and intensity throughout pregnancy.The width of linea nigra is usually around 1 cm it is consistent in width along its entire length.Hyperpigmentation can range from a slight shade of brown to a grayish black.Linea nigra usually extends from the symphysis pubis (the cartilaginous joint between the pubic bones) to the umbilicus (the belly button), but it can extend further up to the xiphoid process (the lowest point on the sternum).Linea nigra is a linear band of macular hyperpigmentation that extends vertically down the midline of the abdomen. What are the clinical features of linea nigra? It is no longer thought that α– and β– melanocyte-stimulating hormone from the pituitary gland causes hyperpigmentation during pregnancy. The placenta also produces bioactive sphingolipids, which upregulate melanogenic enzymes such as tyrosinase and tyrosinase-related proteins 1 and 2.Melanin is deposited in the epidermis and taken up by dermal macrophages.Oestrogen activates intracellular oestrogen α- and β-receptors located in in the skin, stimulating melanocytes to increase melanin output.Increased production of melanin is due to the effects of oestrogen, augmented by progesterone. Linea nigra and other forms of pregnancy-related hyperpigmentation are due to placental hormones, metabolic factors and immunological factors.
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