INTRODUCTIONPregnancy, an endocrine storm, is characterized by altered endocrine, metabolic, and immunologic milieus. These alterations result in both multiple physiologic and pathologic cutaneous changes that may range from normal cutaneous changes to eruptions that appear to be specifically associated with pregnancy [1]. Moreover, pregnancy may modify the course of a number of dermatological conditions. The present study was undertaken to find out the prevalence of the physiological and pathological skin changes -specific dermatoses of pregnancy, various infective and miscellaneous cutaneous diseases in pregnancy and to correlate the prevalence of the major cutaneous changes and diseases in relation to different trimesters of pregnancy and with gravidity. MATERIALS AND METHODSA cross-sectional study was conducted during the period of August 2008 to August 2010. Ethical clearance was sought from Institutional Ethical Committee. After acquiring informed consent, about 500 pregnant women who attended the Outpatient Department of Maternity Hospital, Madras Medical College, Chennai, Tamil Nadu, India during the time period were randomly selected, irrespective of the duration of pregnancy and gravidity. Pregnant women in active labour were excluded from the study. Detailed history and complete dermatological examination was done in all cases to study the physiological and pathological changes of skin and its appendages. Relevant systemic examination and investigations like KOH mount, Gram's stain, Tzanck smear, and liver function test were done if required to confirm the diagnosis. Venereal Disease Research Laboratory (VDRL) and enzyme linked immune sorbent assay for Human Immunodeficiency Virus (HIV) were done in all the cases. Results were tabulated and analysed. STATISTICAL ANALySISStatistical analysis of major cutaneous changes between primigravidas and multigravidas, and between various trimesters was done by Fisher's-exact test and Chi-square test. Statistical analysis was done using software SPSS version 16. A p-value less than 0.05 were considered significant. RESULTSA total of 500 pregnant women were studied from August 2008 to August 2010. Of these, 291 (58.2%) were primigravidas, 209 (41.8%) were multigravidas. Among the multigravidas, 164 (32.8%) were second gravida, 39 (7.8%) were third gravida, and six (1.2%) were fourth gravida. Cases seen in the I st trimester were nine (1.8%), II nd trimester were 87 (17.4%) and III rd trimester were 404 (80.8%).The distribution of physiological skin changes observed during pregnancy (n =500) is shown in [ ABSTRACTIntroduction: Pregnancy produces many cutaneous changes, some of which are specifically related to pregnancy (dermatoses of pregnancy), some are modifiable by pregnancy and others that are common are named physiologic. These physiologic skin changes, usually do not impair the health of the mother or the fetus but some of them can be cosmetically significant and of importance to the dermatologist.

A case of alkaptonuria, a rare disorder with autosomal recessive inheritance, is reported here. The patient had palmar pigmentation in addition to the usual features of alkaptonuria.

Epithelioid hemangioendothelioma is an intermediate-grade vascular tumor arising from the vascular endothelium, which usually arises in soft tissue, and skin involvement is extremely rare. We report a case that presented with primary cutaneous tumor involving the whole limb and was present since birth.

Olmsted syndrome is an uncommon genetic disorder with symmetrical, diffuse, transgredient, mutilating palmoplantar keratoderma and periorificial hyperkeratosis. Olmsted syndrome in a female patient is particularly rare, and we report two unrelated female patients of Olmsted syndrome, who presented with perioral hyperkeratosis and palmoplantar keratoderma. One of our patients also had woolly hair from birth and flexion contracture of a digit, while the other had pseudoainhum. There was no cardiac involvement. Hence, the diagnosis of Olmsted syndrome was made.

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