Differential Diagnosis for Itchy Red Nodules in 3rd Trimester
Single Most Likely Diagnosis
- Intrahepatic Cholestasis of Pregnancy (ICP): This condition is characterized by pruritus and elevated liver enzymes, typically presenting in the third trimester. Although the AST is only slightly elevated, ICP is a common cause of pruritus in pregnancy and should be considered, especially given the normal ALP.
Other Likely Diagnoses
- Pemphigoid Gestationis: An autoimmune skin disorder that occurs during pregnancy, characterized by itchy blisters and nodules. It typically presents in the second or third trimester.
- Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP): A common skin condition in pregnancy, presenting with itchy papules and plaques, often starting in the abdominal striae.
- Atopic Eruption of Pregnancy: A condition that encompasses several skin manifestations, including eczema, which can present with itchy red nodules.
Do Not Miss Diagnoses
- Acute Fatty Liver of Pregnancy (AFLP): A rare but serious condition that can present with elevated liver enzymes and pruritus. Although the AST is only slightly elevated, AFLP is a potentially life-threatening condition that requires prompt diagnosis and treatment.
- HELLP Syndrome: A variant of preeclampsia that can present with elevated liver enzymes and pruritus. It is a serious condition that requires immediate medical attention.
- Cholestasis due to Other Causes: Such as primary biliary cirrhosis or drug-induced cholestasis, which can present with pruritus and elevated liver enzymes.
Rare Diagnoses
- Polymorphic Eruption of Pregnancy: A rare skin condition that can present with itchy red nodules and papules.
- Autoimmune Hepatitis: A rare condition that can present with elevated liver enzymes and pruritus, although it is less common in pregnancy.