Differential Diagnosis for Diffuse Body Itching in Third Trimester of Pregnancy
Single Most Likely Diagnosis
- Intrahepatic Cholestasis of Pregnancy (ICP): This condition is characterized by intense itching, particularly on the palms and soles, without a rash, and is often associated with elevated bile acids. It typically presents in the third trimester and resolves after delivery. The itching can be severe and is often worse at night.
Other Likely Diagnoses
- Puppp (Pruritic Urticarial Papules and Plaques of Pregnancy): Also known as polymorphic eruption of pregnancy, this is the most common dermatosis in pregnancy, presenting with intense itching and a rash, typically starting around the abdomen and spreading to other areas.
- Atopic Dermatitis (Eczema): Pregnancy can exacerbate atopic dermatitis, leading to increased itching and skin lesions.
- Dry Skin (Xerosis): Hormonal changes and stretching of the skin during pregnancy can lead to dryness and itching.
- Allergic Contact Dermatitis: Sensitivity to certain substances can cause an allergic reaction, leading to itching and a rash.
Do Not Miss Diagnoses
- Cholestasis due to other liver diseases (e.g., viral hepatitis, primary biliary cirrhosis): These conditions can present similarly to ICP but have different implications for management and prognosis.
- Thyroid Disorders: Both hyperthyroidism and hypothyroidism can cause itching, although this is less common.
- Hematological Disorders (e.g., iron deficiency anemia): Certain blood disorders can cause itching due to the buildup of substances like bilirubin.
Rare Diagnoses
- Pemphigoid Gestationis: A rare autoimmune skin disorder that causes blistering and itching, typically starting around the navel and spreading.
- Prurigo of Pregnancy: Characterized by extremely itchy nodules on the skin, often on the arms, legs, and abdomen.
- Mastocytosis: A condition involving the accumulation of mast cells in the skin, which can cause itching, hives, and other symptoms.