Pemphigoid gestationis is a severe bullous eruption that occurs in 1 in 60,000 pregnancies.
It is unusual for a primigravid women to be affected. In affected women the skin lesions become progressively more severe during successive pregnancies.
self-limited autoimmune bullous disorder that presents mainly in late pregnancy or the immediate postpartum period but can appear in any of the three trimesters
beyond pregnancy it can also very rarely occur in association with trophoblastic tumors (choriocarcinoma, hydatidiform mole)
also an increased risk to develop other autoimmune diseases, in particular Grave's disease
pemphigoid gestationis tends to recur in subsequent pregnancies, with usually earlier onset and increasing severity. Only very rarely (5%) a pregnancy may be passed over
Pemphigoid gestationis presents with intense pruritus that occasionally may precede the manifestation of skin lesions
initially, erythematous urticarial papules and plaques typically develop on the abdomen
in this so-called pre-bullous stage, differentiation between pemphigoid gestationis and polymorphic eruption of pregnancy is almost impossible, both clinically and histopathologically
occurs during the second and third trimesters of pregnancy
initial sites include the periumbilical area, around the mouth, palms and soles
later lesions may become widespread
after about 4 weeks bullous lesions appear bullous lesions resolve about 4 weeks post-partum
Risk for fetus
increase in prematurity and small-for-date babies
neonatal pemphigus is a rare complication of pregnancy in pemphigus patients
Treatment
seek expert advice
depends on the stage and severity of the disease and aims to control pruritus and to prevent blister formation
in cases of mild pre-blistering pemphigoid, topical corticosteroids with or without oral antihistamines may be sufficient
all other cases require systemic corticosteroids
severe cases may benefit from immunoapheresis
after delivery, if necessary, other immunosuppressive treatment may be used
Reference:
1) Ambros-Rudolph CM. Dermatoses of pregnancy - clues to diagnosis, fetal risk and therapy. Ann Dermatol. 2011 Aug;23(3):265-75.
2) Daneshpazhooh M et al. Pemphigus and pregnancy: a 23-year experience.Indian J Dermatol Venereol Leprol. 2011 Jul-Aug;77(4):534.
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