Itch In Pregnancy

NICE CKS Itch in pregnancy. Last revised: Apr 2025.

Article Last Updated:09/04/2026

Intrahepatic cholestasis of pregnancy is covered in detail in a separate article: Intrahepatic Cholestasis of Pregnancy (ICP)

Dermatoses of pregnancy (causes of itch that are specific to pregnancy):

Feature	Atopic eruption of pregnancy	Polymorphic eruption of pregnancy (PEP)	Pemphigoid gestations	Intrahepatic cholestasis of pregnancy
Onset	1st trimester	3rd trimester	2nd-3rd trimester	3rd trimester
Rash morphology	Eczematous lesions	Pruritic urticarial papules coalescing into plaques	Urticarial papules / plaques progressing to tense blisters	NO rash Scratching may cause excoriation marks
Distribution	Face, neck, upper chest, flexor surfaces	Starts on abdominal straie and may spread to buttocks and thighs Peri-umbilical area spared	Peri-umbilical involvement is characteristic May spread to the whole body	Generalised Classically palm and soles
Diagnosis	Clinical diagnosis		Skin biopsy with direct immunofluorescence	Serum bile acids
Management*	Emollients Topical corticosteroids Sedating antihistamine if sleep is affected		Urgent dermatology and obstetric referral Mild: topical corticosteroid + antihistamines Moderate / severe: systemic corticosteroids	Symptomatic relief with topical emollients and/or antihistamines Planned early delivery based on serum bile acid levels
Prognosis	Resolves after delivery	Resolves within 1 week postpartum	Resolves weeks to months postpartum	Resolves within days to weeks postpartum

*Self-care advice for itch in pregnancy (applicable to all dermatoses of pregnancy):

Bathing	Keep baths to <20 minutes and bathe less frequently where possible Use cool or lukewarm water (as hot water dries the skin) Avoid soap, bubble bath, and perfumed products Use a mild alcohol-free cleanser or emollient as soap substitute Pat skin dry and avoid vigorous rubbing A cool shower may give short-term relief, but excessive showering dries the skin
Skin and nails	Keep nails short to minimise excoriation Rub rather than scratch if the urge is irresistible
Environment and clothing	Keep the indoor environment cool Especially the bedroom Consider humidifying the air in winter Wear cotton or silk Avoid wool and synthetic fabrics
Diet and lifestyle	Avoid spicy food, alcohol, and caffeine (as vasodilation can worsen itching)

Be aware of other causes of itch that are NOT related to pregnancy:

NO rash	Opioids Thyroid disorders (thyrotoxicosis > hypothyroidism) (see the Thyroid Disorders in Pregnancy article for more information) Iron deficiency Liver disease (usually secondary to cholestasis) CKD
With rash	Chickenpox (see the Chickenpox in Pregnancy article for more information) Scabies Urticaria Rubella Insect bites

Reference

You must be logged in to post a comment.