Ms Nicole Wong1, Dr Helen Douglas2, Dr Anna Goodwin-Walters2
1The University of Auckland, Faculty of Medical and Health Sciences, Auckland, New Zealand, 2State Adult Burns Unit, Murdoch, Australia
Background:It is well accepted that a variety of pigmentation changes occur in over 90% of pregnant women. Regions that are hyper-pigmented in the non-pregnant state become further pigmented during pregnancy. Little is known about how pregnancy affects scar pigmentation and cosmesis following burn injury.
Case and Literature Review:We present the case of a 38-year-old Afghani woman in her first trimester of pregnancy who sustained a scald burn to her left calf (1.5% TBSA) and left wrist (<1% TBSA). These wounds were managed conservatively and healed within 15 days. At her 3-month review there was a flat but significantly hyper-pigmented area over the healed wound despite timely healing and strict sun avoidance. A thorough search of the literature did not reveal any similar reported cases and few articles reported on scar outcomes of the pregnant burn patient. Full details of the case and a review of the current evidence regarding burns, wound healing and scarring in the pregnant patient is presented.
Discussion:The relative immunosuppression of pregnancy has led some researchers to postulate that scar formation in this group may be favourable, whilst others report a negative impact of pregnancy hormones on wound healing. However, it is possible that raised levels of oestrogen and progesterone (known melanocytic stimulators) in the gravid patient contribute to hyperpigmentation of wounds, even in those healed within a timely fashion. Whether this pigmentation will resolve or improve post-partum and on the cessation of breast-feeding is another question we are interested to answer.
Nicole Wong is a final year medical student from The University of Auckland, New Zealand. Nicole undertook her selective clinical placement at the State Adult Burns Unit, Fiona Stanley Hospital, WA.