Pemphigoid gestationis

Pemphigoid gestationis is a rare autoimmune blistering disease of pregnancy. It is characterized by pruritic, urticarial plaques with the development of tense vesicles and bullae within the lesions. Pemphigoid gestationis has been associated with premature delivery, small-for-gestational-age infants. Recurrences with subsequent pregnancies are often more severe. Oral glucocorticoids are the mainstay of therapy. Differentiation of pemphigoid gestationis from pruritic urticarial papules and plaques of pregnancy is essential because management and outcomes differ. In instances in which clinical diagnosis is difficult, direct immunofluorescence tests, immunoblots, or ELISA studies of anti-basement-membrane zone antibodies are useful in establishing the diagnosis.

[Pemphigoid gestationis]

Pemphigoid gestationis (PG) is a rare autoimmune bullous dermatosis associated with pregnancy. Its previous designation, herpes gestationis, is obsolete. PG is characterized by a subepidermic separation induced by the presence of peripheral blood autoantibodies against two hemidesmosomal antigens: BPAG1 and BPAG2. Clinical diagnosis is confirmed by histology and positive cutaneous immunofluorescence tests. The most discriminant examination for other pruritic dermatoses of pregnancy is the enzyme-linked immunosorbent assay (Elisa) NC16A BP 180. First-line treatment is local corticosteroid therapy; if local treatment fails, general corticosteroid therapy should be administered. The prognosis is good for mother and child, except that there is a risk of preterm delivery and of moderate fetal growth restriction. Management in a specialized setting is therefore necessary. Recurrence is possible during subsequent pregnancies.

A case of gestational diabetes arising following treatment with glucocorticosteroids for pemphigoid gestationis

A case of pemphigoid gestationis, a rare autoimmune disease unique to pregnancy, is described. To control the skin lesions systemic corticosteroids were required. The patient developed gestational diabetes mellitus. The pregnancy continued to 37 weeks and a live male infant was delivered. There was no evidence of macroscopic changes in the placenta. The skin lesions resolved in the postpartum period.

Specific pregnancy dermatoses

The specific dermatoses of pregnancy are a rare group of skin diseases specifically related to pregnancy. Diagnostic clues are outlined in a diagrammatic way that can facilitate the recognition between dermatoses of pregnancy in daily dermatology clinic practice.

[Diagnostic image. A woman in childbed with itch and vesicles]

A 37-year-old woman in childbed developed gestational pemphigoid.

Pemphigoid gestationis: clinical and laboratory evaluation

INTRODUCTION

Pemphigoid gestationis, also known as herpes gestationis, is a rare autoimmune blistering disease associated with pregnancy. It usually occurs during the second or third trimester, but it may be present at any stage of pregnancy or the puerperium. The clinical, histologic, and immunopathological features of pemphigoid gestationis are similar to those of the pemphigoid group of disorders.

METHODS

We hereby report seven patients who were diagnosed with pemphigoid gestationis and followed at the Autoimmune Blistering Disease Clinic in the Department of Dermatology of the University of Sao Paulo Medical School between 1996 and 2008.

DISCUSSION

Demographic and clinical findings, such as median age, sites of involvement, and gestational age of onset or C3 of our patients, coincide with those described in previous reports. The majority of patients (85%) exhibited complement C(3) and immunoglobulin G (IgG) deposition along the basement membrane zone (BMZ) on immunofluorescence. Herpes gestationis factor (HG) factor was postitive in four out of six patients (67%), and three out of five patients recognized the bullous pemphigoid recombinant antigen (BP180) by ELISA.

CONCLUSION

This study revealed a good outcome of the newborns from pemphigoid gestationis affected mothers, based on the absence of pemphigoid gestationis cutaneous lesions, mean birth weight, and normal Apgar scores and gestational age at birth.

Clinical experience in pemphigoid gestationis: Report of 10 cases

BACKGROUND

Pemphigoid gestationis is a rare autoimmune blistering disease that occurs during pregnancy.

OBJECTIVE

This study reviewed our clinical experience with pemphigoid gestationis.

METHODS

We reviewed medical records of 10 patients with pemphigoid gestationis seen at Mayo Clinic, Rochester, Minnesota, between 1976 and 2004.

RESULTS

Urticarial papules were the most frequent clinical presentation followed by blisters and rash. Pruritus was the cardinal symptom. Lesions presented initially on the legs, thighs, back, and chest. Direct immunofluorescence had the highest diagnostic test sensitivity. Systemic corticosteroids were the mainstay of treatment. Fetal and maternal outcome was good in all cases.

LIMITATIONS

This was a retrospective, single-institution study.

CONCLUSIONS

This condition can be easily confused with other dermatoses of pregnancy, for example, pruritic urticarial papules of pregnancy. Biopsy for direct immunofluorescence is the preferred test for confirmation of diagnosis. On the basis of good patient outcomes, conservative treatment seems warranted.

Pemphigoid gestationis: report of a case with umbilical artery Doppler assessment

BACKGROUND

Pemphigoid gestationis is a rare autoimmune disorder of pregnancy characterized clinically by a pruritic, papular rash and in some cases intrauterine growth restriction and premature delivery. The growth disorder is secondary to antibody deposition in the placental bed, with resultant placental insufficiency. The appropriate fetal assessment required during these gestations remains uncertain. The use of serial Doppler velocimetry of the umbilical arteries has not been reported to date in this disorder.

CASE

A woman had pemphigoid and progressively decreasing umbilical artery end-diastolic flow over a period of weeks without documented fetal growth restriction. Delivery was finally prompted by reversal of end-diastolic flow.

CONCLUSION

We suggest that parturients with this condition undergo frequent umbilical artery Doppler studies to document end-diastolic velocity even without the ultrasound finding of intrauterine growth restriction.

Herpes gestationis

Herpes gestationis, also known as Pemphigoid gestationis, is a rare autoimmune disease of pregnancy. It is characterized by itching and skin lesions. The disease causes prominently maternal discomfort but fetal and neonatal complications have been reported. There are only scattered reports of cutaneous neonatal herpes gestationis in the literature; however, the frequency and severity of fetal illness are still debated. We describe 2 cases of herpes gestationis diagnosed and managed at the King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia.

[Herpes gestationis]

Herpes Gestationis is a serious dermatological disease, albeit rare, associated to pregnancy or to the trophoblast diseases. Contrary to what the name suggests, it is not a viral disease but an auto-immune disease. We present the clinical case of a 38 year-old woman to whom a case of Herpes Gestationis was diagnosed when she was 15 weeks pregnant and whom has been treated with corticosteroids and antihistamine's showing positive results and without major complications for the mother or the embryo. The authors are undertaking a review of the existing literature, based on this clinic case.

A case of chronic herpes gestationis: persistent disease or conversion to bullous pemphigoid?

We report the case of a 38-year-old woman with herpes gestationis (HG) persistent for 26 months postpartum with typical erythematous-edematous grouped lesions associated with vesicles, blisters, and scaled crusts on most parts of her body. Despite high doses of oral prednisolone, azathioprine, and dapsone, and a trial of 5 plasmaphereses, the disease has persisted to date. Histopathologic examination of lesional skin showed subepidermal blisters, focal basal cell necrosis, and a dermal inflammatory infiltrate including many eosinophils. Direct immunofluorescence showed linear C3 staining in the basement membrane zone and the complement fixation test demonstrated circulating antibasement membrane zone antibodies at a low titer (1:80). HLA typing demonstrated an A2, A24, B35, B52, DR4,5, DR13,15, DRW52,53 phenotype. We present this case as chronic persistent HG and discuss the differential diagnosis between chronic persistent HG and HG evolving to bullous pemphigoid, together with a careful examination of similar cases reported in literature.

[Severe form of herpes gestationis]

We report a very severe form of herpers gestationis that arose at the 26(th) week of pregnancy and reached us for observation at the 30(th) week. Herpes gestationis in an autoimmune vesicobullous dermatosis characterised by skin eruptions, intense itching and consequent increase in fetal morbility, with delayed intrauterine growth and prematurity. Owing to its particular severity (involvement of the entire body surface including the face), between the 30th and the 32(nd) weeks we had to address a severe clinical condition characterised by anaemia, marked hypoproteinaemia, hypoalbuminaemia, hupertension and hyperglycaemia which led us to resort to the maximum dose of oral corticotherapy in association with topical therapy using clobetasol propionate. In our opinion the results obtained were highly statisfactory with the result that at the end of the 37(th) week, in consideration of the patient's obstetric history, podalic presentation and parity, we performed a Caesarean delivering a newborn of 3000 g in excellent condition. The patient was discharged symptom-free on the 6(th) day and the newborn was in full healt.

Clinicopathological features and HLA tissue typing in pemphigoid gestationis patients in Kuwait

Pemphigoid gestationis (PG) is a rare autoimmune disease of pregnancy. We report a series of 22 cases of PG in Kuwait. They constituted 18% of all the autoimmune bullous diseases registered in our centre over a span of 11 years. PG was observed to be the third most common bullous disease in our region. Ninety-five per cent of the patients were of Arab ethnicity. The clinical features observed in our patients were comparable to those reported elsewhere. Systemic steroids (prednisolone 20-60 mg daily) remained the mainstay of treatment to control the active disease and an optimal dose of 20 mg of prednisolone was maintained throughout the pregnancy and immediate postpartum period. We observed a favourable outcome of pregnancies complicated by PG without any associated maternal or foetal morbidity. Kuwaiti patients with PG were observed to have a predominance of HLA-DR3 and DQ2 antigens. No predominance of HLA-DR4 antigen was observed.

[Case of herpes gestationis in 5th pregnancy]

We analyze the case of herpes gestationis to 36 year-old woman, which started on 24th week of 5th gestation. During the past gestations there were no fillings. Treatment with prednisolon 40 mg per day only reduced the signs. After the birth treatment with dapson 100 mg per day for the 5-days period gave a visible effect quickly. The treatment was completed 3 months ago and now there are no signs of illness.