1
|
Kano Y, Kato M. Periumbilical blisters: pemphigus vulgaris during pregnancy. Am J Obstet Gynecol 2023; 229:688-689. [PMID: 37271432 DOI: 10.1016/j.ajog.2023.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 05/23/2023] [Indexed: 06/06/2023]
Affiliation(s)
- Yasuhiro Kano
- Department of Emergency and General Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan; Department of Dermatology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
| | - Miyuki Kato
- Department of Dermatology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| |
Collapse
|
2
|
Recognizing, Diagnosing, and Managing Pregnancy Dermatoses. Obstet Gynecol 2022; 140:679-695. [PMID: 36075066 DOI: 10.1097/aog.0000000000004938] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/26/2022] [Indexed: 01/05/2023]
Abstract
Pregnancy dermatoses are inflammatory skin disorders that occur during pregnancy or immediately postpartum. This heterogenous group of disorders includes pemphigoid gestationis, polymorphic eruption of pregnancy, intrahepatic cholestasis of pregnancy, atopic eruption of pregnancy, and pustular psoriasis of pregnancy. In this article, we provide a comprehensive literature review of each condition focusing on nomenclature, epidemiology, pathogenesis, clinical presentation, diagnosis, differential diagnosis, maternal risk, fetal risk, and treatment. We aim to increase awareness and help clinicians recognize, diagnose, and manage these unique conditions.
Collapse
|
3
|
Puri N, Alagappan A, Brar BK, Singh O. A Rare Case of Recurrent Postpartum Pemphigoid Gestationis with Fetal Complications and Skip Pregnancy. Indian Dermatol Online J 2020; 11:995-996. [PMID: 33344355 PMCID: PMC7734992 DOI: 10.4103/idoj.idoj_93_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/29/2020] [Accepted: 08/16/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Neerja Puri
- Department of Dermatology, Venereology, Leprology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Anjugam Alagappan
- Department of Dermatology, Venereology, Leprology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Balvinder Kaur Brar
- Department of Dermatology, Venereology, Leprology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Onkar Singh
- Department of Dermatology, Venereology, Leprology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| |
Collapse
|
4
|
Abel MK, Suresh R, Raffi J, McCalmont TH, Murase JE. Diagnostic testing in gestational bullous pemphigoid: Has enzyme-linked immunosorbent assay replaced direct immunofluorescence as the new gold standard? JAAD Case Rep 2019; 5:1081-1083. [PMID: 31799358 PMCID: PMC6881635 DOI: 10.1016/j.jdcr.2019.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Mary Kathryn Abel
- Department of Dermatology, University of California, San Francisco, California
| | - Raagini Suresh
- Department of Dermatology, University of California, San Francisco, California
| | - Jodie Raffi
- Department of Dermatology, University of California, San Francisco, California
- University of California, Irvine School of Medicine, Irvine, California
| | - Timothy H. McCalmont
- Department of Dermatology, University of California, San Francisco, California
- Department of Pathology, University of California, San Francisco, California
| | - Jenny E. Murase
- Department of Dermatology, University of California, San Francisco, California
- Department of Dermatology, Palo Alto Foundation Medical Group, Mountain View, California
- Correspondence to: Jenny E. Murase, MD, Department of Dermatology, Palo Alto Foundation Medical Group, 701 East El Camino Real (31-104), Mountain View, CA 94040.
| |
Collapse
|
5
|
Krain RL, Chen KL, Werth VP. Management of autoimmune blistering diseases in pregnancy and the neonate. GIORN ITAL DERMAT V 2019; 154:539-549. [PMID: 31195784 DOI: 10.23736/s0392-0488.19.06375-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The management of autoimmune blistering diseases (AIBD) is therapeutically challenging, particularly in patients who plan to conceive, or are pregnant or breastfeeding. Not only is a patient's immune system altered by pregnancy-associated hormonal changes, but several medications used for AIBD treatment are not recommended for use in pregnancy or lactation. The data acquired regarding the safety and efficacy of these therapeutic interventions are gathered from studies or case reports from other diseases, as the treatment modalities are similar and randomized controlled trials are typically not performed in the setting of pregnancy. Although some medications for AIBD treatment are considered unsafe for use in pregnancy, many effective and tolerable therapies are able to provide benefit to these patients. In fact, most first-line agents may be used in pregnancy, to a given extent. This article discusses the medications used to treat AIBD prior to conception, during pregnancy, and while breastfeeding, as well as highlights those that are contraindicated. The preferred approach to management in these patients is also discussed. Additionally, we present the available information regarding neonates of mothers with a diagnosis of AIBD, including the likelihood, identification, and management of neonatal blistering and the effects from medication exposure in utero.
Collapse
Affiliation(s)
- Rebecca L Krain
- Department of Dermatology, Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA.,Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Kristen L Chen
- Department of Dermatology, Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA.,Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Victoria P Werth
- Department of Dermatology, Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA - .,Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
6
|
Cohen S, Strowd LC, Pichardo RO. Pemphigoid gestationis: a case series and review of the literature. J DERMATOL TREAT 2018; 29:815-818. [DOI: 10.1080/09546634.2018.1459034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Stephanie Cohen
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lindsay C. Strowd
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Rita O. Pichardo
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
7
|
Zubor P, Svecova I, Moricova P, Pec J, Adamicova K, Danko J. Early flare-up of severe Herpes gestationis (Pemphigoid gestationis) and successfull prolonged treatment: A case report. J OBSTET GYNAECOL 2017; 37:824-826. [PMID: 28399702 DOI: 10.1080/01443615.2017.1305334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Pavol Zubor
- a Department of Obstetrics and Gynecology , University Hospital Martin and Jessenius Faculty of Medicine, Comenius University , Martin , Slovakia.,b Biomedical Center Martin, Jessenius Faculty of Medicine , Comenius University , Martin , Slovakia
| | - Iveta Svecova
- a Department of Obstetrics and Gynecology , University Hospital Martin and Jessenius Faculty of Medicine, Comenius University , Martin , Slovakia
| | - Petra Moricova
- a Department of Obstetrics and Gynecology , University Hospital Martin and Jessenius Faculty of Medicine, Comenius University , Martin , Slovakia
| | - Juraj Pec
- c Dermatovenerologic Clinic , University Hospital Martin and Jessenius Faculty of Medicine, Comenius University , Martin , Slovakia
| | - Katarina Adamicova
- d Department of Pathological Anatomy , University Hospital Martin and Jessenius Faculty of Medicine, Comenius University , Martin , Slovakia
| | - Jan Danko
- a Department of Obstetrics and Gynecology , University Hospital Martin and Jessenius Faculty of Medicine, Comenius University , Martin , Slovakia
| |
Collapse
|
8
|
Pemphigoid gestationis: Clinical and histologic features of twenty-three patients. Int J Womens Dermatol 2016; 3:86-90. [PMID: 28560301 PMCID: PMC5440447 DOI: 10.1016/j.ijwd.2016.11.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 10/25/2016] [Accepted: 11/03/2016] [Indexed: 12/12/2022] Open
|
9
|
Retrospective analysis of pemphigoid gestationis in 32 Saudi patients - Clinicopathological features and a literature review. J Reprod Immunol 2016; 116:42-5. [PMID: 27175516 DOI: 10.1016/j.jri.2016.04.286] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 03/23/2016] [Accepted: 04/20/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Pemphigoid gestationis (PG) is a rare autoimmune-mediated blistering disease that mainly affects pregnant women in their 2nd or 3rd trimester and immediate postpartum period. In addition to the clinical assessment, the diagnosis of PG is usually confirmed by histological and immunological studies. PG usually flares up at the time of delivery and spontaneously improves postpartum. Prompt recognition and appropriate management may reduce morbidity associated with this disorder. This study aimed to determine the clinical, histopathological features and treatment of PG of Saudi patients. MATERIALS AND METHODS A retrospective study of 32 patients with pemphigoid gestationis (PG) was conducted from 1990 to 2014 at King Khalid University Hospital and Derma Medical Center, Riyadh, Saudi Arabia. Data regarding epidemiology, medical histories, clinical course, diagnostic test results and management were collected and analyzed. RESULTS A total of 32 patients with PG were analyzed. The mean age was 31.9 years. Seventy-four percent of the patients were multigravidas, and 2 patients were primigravidas. One hundred percent of the cases were singleton pregnancies. Eighty-four percent of the cases had the onset of PG during the 2nd and 3rd trimesters. One hundred percent of patients complained of pruritus, and 94% reported this as the first symptom. Erythematous plaques and vesiculobullous eruption were the most common skin presentation. The primary sites of involvement were the abdomen, trunk, lower (mainly thighs) and upper limbs. The face and mucus membranes were rarely involved. Fifty percent of patients had recurrent symptoms with their next pregnancy. Direct immunofluorescence revealed a linear deposition of the third component of the complement along the basement membrane zone in all cases (C3),while most of the cases showed positive linear deposition of IgG. Seventy five percent of our patients had a good response to oral corticosteroids, and only one patient needed IVIG. The vast majority of the patients (61%) became free of symptoms within 1-2 months of treatment. In 53% of the patients, maternal and fetal outcomes were good with no complications. Six pregnancies were complicated by preterm labor, 2 experienced IUGR (intrauterine growth restriction), and 2 had an abortion or stillbirth. CONCLUSION Our study does not differ dramatically when comparing the onset of PG, the high frequency of multigravida women, the clinical course and good patient outcomes but we observed that the first attack extended from primigravida to 11th pregnancy and slight increase in recurrence rate. Finally the timely diagnosis and appropriate management of PG may improve both maternal and neonatal outcome.
Collapse
|
10
|
Hakimi I, Benabdejlil Y, Ourraï A, Kouach J, Moussaoui D, Deyahni M. [Pemphigoid gestationis and aplasia cutis congenita: report of a case]. Pan Afr Med J 2015; 19:47. [PMID: 25667709 PMCID: PMC4315481 DOI: 10.11604/pamj.2014.19.47.4914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 08/10/2014] [Indexed: 11/11/2022] Open
Abstract
La pemphigoïde gestationis est une dermatose gravidique apparaissant en général entre la 28ème et la 32ème semaine d'aménorrhée. L’éruption cutanée est prurigineuse, bulleuse ou vésiculopapuleuse et de topographie péri-ombilicale. Outre la clinique, son diagnostic repose sur la biopsie cutanée avec analyse en immunofluorescence directe. Elle se caractérise par sa tendance à récidiver. Le traitement habituel nécessite des dermocorticoïdes. Les conséquences peuvent être maternelles (menace d'accouchement prématuré), fœtales (retard de croissance intra-utérin), et néo-natales (éruption cutanée). Nous rapportons un cas de pemphigoïde gestationis associé à une aplasie cutanée congénitale type 2. S'agit il d'une association fortuite?
Collapse
Affiliation(s)
- Ihssane Hakimi
- Service de Gynécologie-Obstétrique, Hôpital Militaire d'instruction Mohammed V, Rabat, Maroc
| | - Youssef Benabdejlil
- Service de Gynécologie-Obstétrique, Hôpital Militaire d'instruction Mohammed V, Rabat, Maroc
| | - Abdelhakim Ourraï
- Service de Pédiatrie, Hôpital Militaire d'instruction Mohammed V, Rabat, Maroc
| | - Jaouad Kouach
- Service de Gynécologie-Obstétrique, Hôpital Militaire d'instruction Mohammed V, Rabat, Maroc
| | - Driss Moussaoui
- Service de Gynécologie-Obstétrique, Hôpital Militaire d'instruction Mohammed V, Rabat, Maroc
| | - Mohammed Deyahni
- Service de Gynécologie-Obstétrique, Hôpital Militaire d'instruction Mohammed V, Rabat, Maroc
| |
Collapse
|
11
|
Recognizing presentations of pemphigoid gestationis: a case study. Case Rep Obstet Gynecol 2014; 2014:415163. [PMID: 25506008 PMCID: PMC4251881 DOI: 10.1155/2014/415163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 10/31/2014] [Accepted: 10/31/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction. Pemphigoid gestationis (PG) is an autoimmune blistering disease that occurs in approximately 1 in 50,000 pregnancies. Failing to recognize PG may lead to inadequate maternal treatment and possible neonatal complications. Case Report. At 18 weeks of gestation, a 36-year-old otherwise healthy Caucasian G4P1 presented with pruritic papules on her anterior thighs, initially treated with topical steroids. At 31 weeks of gestation, she was switched to oral steroids after her rash and pruritus worsened. The patient had an uncomplicated SVD of a healthy female infant at 37 weeks of gestation and was immediately tapered off steroid treatment, resulting in a severe postpartum flare of her disease. Discussion. This case was similar to reported cases of pruritic urticarial papules followed by blisters; however, this patient had palm, sole, and mucous membrane involvement, which is rare. Biopsy for direct immunofluorescence or ELISA is the preferred test for diagnosis. Previous case reports describe severe postdelivery flares that require higher steroid doses. Obstetrical providers need to be familiar with this disease although it is rare, as this condition can be easily confused with other dermatoses of pregnancy. Adequate treatment is imperative for the physical and psychological well-being of the mother and infant.
Collapse
|
12
|
Abstract
The specific dermatoses of pregnancy represent a diverse group of intensely pruritic dermatoses, occurring only in the puerperal state. The relative rarity of these conditions, the often variable clinical appearance, and the lack of definitive diagnostic tests have led to confusion regarding the appropriate diagnosis and management of the specific dermatoses of pregnancy. Herein we review the clinical characteristics, diagnosis and treatment of five dermatoses occurring during pregnancy: pruritic urticarial papules and plaques of pregnancy, atopic eruption of pregnancy, pemphigoid gestationis, intrahepatic cholestasis of pregnancy, and pustular psoriasis of pregnancy.
Collapse
Affiliation(s)
- Stephanie Lehrhoff
- The Ronald O. Perelman Department of Dermatology, New York University, New York, New York 10016, USA.
| | | |
Collapse
|
13
|
Kroumpouzos G. Specific dermatoses of pregnancy: advances and controversies. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.10.59] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
14
|
Guldrís EM, Couceiro E. Pemphigoid gestationis. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013; 35:687. [PMID: 24007701 DOI: 10.1016/s1701-2163(15)30854-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Eva M Guldrís
- Department of Obstetrics and Gynaecology, Vigo University Hospital Complex, Spain
| | | |
Collapse
|
15
|
Pemphigoïde gestationnelle. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013. [DOI: 10.1016/s1701-2163(15)30855-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
16
|
|
17
|
Tbatou F, Studer M, Dellestable P, Huriet V, Cuny JF, Barbaud A, Schmutz JL. [Post-abortion pemphigoid gestationis]. Ann Dermatol Venereol 2012; 139:742-3. [PMID: 23199774 DOI: 10.1016/j.annder.2012.06.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Revised: 05/13/2012] [Accepted: 06/28/2012] [Indexed: 11/30/2022]
|
18
|
|
19
|
|
20
|
Estève E. [Pemphigoid gestationis]. Presse Med 2010; 39:1071-5. [PMID: 20692802 DOI: 10.1016/j.lpm.2009.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Revised: 08/04/2009] [Accepted: 09/02/2009] [Indexed: 10/19/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Eric Estève
- CHR Orléans, hôpital Porte-Madeleine, service de dermatologie, rue Porte-Madeleine, 45032 Orléans cedex 1, France.
| |
Collapse
|
21
|
Abstract
The skin changes in pregnancy can be either physiological (hormonal), changes in pre-existing skin diseases or development of new pregnancy specific dermatoses. Pregnancy-specific skin dermatoses include an ill-defined heterogeneous group of pruritic skin eruptions which are seen only in pregnancy. These include atopic eruption of pregnancy, polymorphic eruption of pregnancy, pemphigoid gestationis and intrahepatic cholestasis of pregnancy. Atopic eruption of pregnancy is the most common of these disorders. Most skin eruptions resolve postpartum and require only symptomatic treatment. Antepartum surveillance is recommended for patients with pemphigoid gestationis and intrahepatic cholestasis of pregnancy as they carry fetal risk. This article deals with the classification, clinical features and treatment of the specific dermatoses of pregnancy.
Collapse
|
22
|
|
23
|
Affiliation(s)
- M Nair
- Department of Obstetrics and Gynaecology, Wythenshawe Hospital, Manchester, UK.
| | | | | |
Collapse
|
24
|
Cobo MF, Santi CG, Maruta CW, Aoki V. Pemphigoid gestationis: clinical and laboratory evaluation. Clinics (Sao Paulo) 2009; 64:1043-7. [PMID: 19936176 PMCID: PMC2780519 DOI: 10.1590/s1807-59322009001100002] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Accepted: 05/06/2009] [Indexed: 11/22/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Marina Flangini Cobo
- Department of Dermatology, Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil
| | | | | | | |
Collapse
|
25
|
Hoftman AC, Hernandez MI, Lee KW, Stiehm ER. Newborn illnesses caused by transplacental antibodies. Adv Pediatr 2008; 55:271-304. [PMID: 19048734 DOI: 10.1016/j.yapd.2008.07.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Alice Chang Hoftman
- Division of Immunology/Allergy/Rheumatology, Mattel Children's Hospital at UCLA, UCLA Center for Health Sciences, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | | | | | | |
Collapse
|
26
|
Hon KLE, Chiu LSM, Lam MCA, Choi CLP, Chan S, Luk NM. Measurement of pruritus in a Chinese woman with pemphigoid gestationis using a wrist movement detector. Int J Dermatol 2007; 47:64-7. [DOI: 10.1111/j.1365-4632.2007.03281.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
27
|
Hon KLE, Chiu LSM, Lam MCA, Choi CLP, Chan S, Luk NM. Normal neonatal outcome in a Chinese woman with pemphigoid gestationis, Graves' disease, and history of placental chorioangioma. Int J Dermatol 2007; 46:996-7. [PMID: 17822510 DOI: 10.1111/j.1365-4632.2007.03292.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
28
|
Brzoza Z, Kasperska-Zajac A, Oleś E, Rogala B. Pruritic urticarial papules and plaques of pregnancy. J Midwifery Womens Health 2007; 52:44-8. [PMID: 17207750 DOI: 10.1016/j.jmwh.2006.09.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pruritic urticarial papules and plaques of pregnancy (PUPPP) are among the most common pruritic dermatoses observed in pregnant women. PUPPP appears most frequently in the third trimester, in primigravidas, and in multiple gestation pregnancies. The eruption of changes occurs initially on the abdomen and extends over the thighs, legs, back, buttocks, arms, and breasts. Skin changes typical for PUPPP are erythematous, urticarial plaques, and papules. Rash regression is usually observed within 6 weeks postpartum. Immunologic mechanisms, hormonal abnormalities, and abdominal skin distension have been suggested as etiologic mechanisms. PUPPP is thought to be harmless for the mother and fetus and usually requires intervention only for symptom relief. In some cases, laboratory investigation, histologic examination, and immunologic study should be performed to exclude more serious disorders of pregnancy, such as herpes gestationis or intrahepatic cholestasis of pregnancy. This article reviews the epidemiology, clinical manifestation, etiology, differential diagnosis, and treatment of PUPPP.
Collapse
Affiliation(s)
- Zenon Brzoza
- Clinical Department of Internal Diseases, Allergology and Clinical Immunology, Medical University of Silesia, Katowice, ul. 3 Maja 13-15, 41-800 Zabrze, Poland.
| | | | | | | |
Collapse
|
29
|
Castro LA, Lundell RB, Krause PK, Gibson LE. Clinical experience in pemphigoid gestationis: Report of 10 cases. J Am Acad Dermatol 2006; 55:823-8. [PMID: 17052488 DOI: 10.1016/j.jaad.2006.07.015] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2006] [Revised: 07/11/2006] [Accepted: 07/18/2006] [Indexed: 12/01/2022]
Abstract
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.
Collapse
Affiliation(s)
- Luis A Castro
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota 55905, USA
| | | | | | | |
Collapse
|
30
|
Abstract
Herpes gestationis, coined by Milton in 1872, or gestational pemphigoid is the most clearly characterized dermatosis of pregnancy. It is a rare vesiculo-bullous eruption that develops during the last trimester or even postpartum and creates severe pruritus. Its etiology is unknown, but it is considered as an autoimmune-mediated dermatosis closely related to the pemphigoid group. Herpes gestationis is associated with a positive C3 deposition along the base of the epidermis in salt-split skin, with increased frequency of HLA-DR3 and also the combination DR3 and DR4. It has a high risk of prematurity and disappears in the postpartum period within weeks or months.
Collapse
|
31
|
High WA, Hoang MP, Miller MD. Pruritic Urticarial Papules and Plaques of Pregnancy With Unusual and Extensive Palmoplantar Involvement. Obstet Gynecol 2005; 105:1261-4. [PMID: 15863603 DOI: 10.1097/01.aog.0000159564.69522.f9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pruritic urticarial papules and plaques of pregnancy (PUPPP) is a specific dermatosis of pregnancy common to primigravid women in the third trimester. The rash usually begins on the lower abdomen within striae and spreads to the proximal extremities. Involvement of face, palms, and soles is unusual. Although intensely pruritic, the fetus is unaffected, and the condition does not usually recur. It can be difficult to distinguish PUPPP from pemphigoid gestationis, an autoimmune bullous disorder with potential fetal consequences that may recur with subsequent pregnancy, menses, or hormonal therapy. CASE A young secundagravida at 36 weeks of gestation with monochorionic twins presented with a 3-week history of a pruritic papular eruption that began on the abdomen and spread to the extremities. She had extensive involvement of the distal extremities, including the palmoplantar surfaces, with small vesicles of 2-4 mm on acral skin. Because of her unusual presentation, she was thought initially to have pemphigoid gestationis. Subsequent dermatological evaluation and a biopsy confirmed the diagnosis of PUPPP. Shortly after admission she delivered 2 healthy male infants, and her rash cleared with conservative management. CONCLUSION Pruritic urticarial papules and plaques of pregnancy often, but not always, spares the face, palms, and soles. Small vesicles can occur in PUPPP, but formation of true bullae is not observed. Careful dermatological examination and cutaneous biopsy can assist in differentiating PUPPP from pemphigoid gestationis, which is essential for treatment and prognosis.
Collapse
Affiliation(s)
- Whitney A High
- Department of Dermatology, Pathology, the University of Texas Southwestern Medical Center at Dallas, Texas, USA
| | | | | |
Collapse
|
32
|
Sitaru C, Powell J, Messer G, Bröcker EB, Wojnarowska F, Zillikens D. Immunoblotting and enzyme-linked immunosorbent assay for the diagnosis of pemphigoid gestationis. Obstet Gynecol 2004; 103:757-63. [PMID: 15051570 DOI: 10.1097/01.aog.0000115506.76104.ad] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate the sensitivity of immunoblotting and enzyme-linked immunosorbent assay (ELISA) to detect autoantibodies to bullous pemphigoid antigen 180 in patients with pemphigoid gestationis and to correlate autoantibody serum levels with disease activity. METHODS In serum samples obtained from 44 pregnant patients before initiation of therapy and from the same number of healthy blood donors, the autoantibody reactivity was assayed by immunofluorescence microscopy on human skin sections as well as Western blot analysis and 2 different ELISAs by using recombinant forms of the immunodominant domain of BP180. In addition, ELISA reactivity with this autoantigen was assayed in 6 patients during the course of the disease, and its correlation with the clinical disease activity was estimated by applying the Spearman rank correlation test. RESULTS By indirect immunofluorescence microscopy, complement-fixing autoantibodies to the dermal-epidermal junction were found in 93% of patients' sera. By immunoblotting and ELISA, autoantibodies to bullous pemphigoid antigen 180 were detected in 93% and 86.3% of pemphigoid gestationis patients, respectively, but in none of the healthy controls. Serum levels of autoantibodies as detected by ELISA paralleled the patients' disease activity. CONCLUSIONS Our study shows that immunoblotting and ELISA are sensitive tools for the detection of autoantibodies to bullous pemphigoid antigen 180 in patients with pemphigoid gestationis. In addition, the ELISA is useful to monitor autoantibody serum levels. LEVEL OF EVIDENCE II-2
Collapse
Affiliation(s)
- Cassian Sitaru
- Department of Dermatology, University of Würzburg, Würzburg, Germany
| | | | | | | | | | | |
Collapse
|
33
|
Günther C, Wozel G, Dressler J, Meurer M, Pfeiffer C. Tissue Eosinophilia in Pemphigoid Gestationis: Association with Eotaxin and Upregulated Activation Markers on Transmigrated Eosinophils. Am J Reprod Immunol 2004; 51:32-9. [PMID: 14725564 DOI: 10.1046/j.8755-8920.2003.00118.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PROBLEM We studied chemotactic cytokines and activation of skin-homed eosinophils in pemphigoid gestationis, a rare autoimmune bullous disease of late pregnancy. METHOD OF STUDY Eotaxin and interleukin (IL)-5 were analysed in patients' blister fluid and serum by enzyme-linked immunosorbent assay. Lesional tissue was investigated for eotaxin deposition by immunohistochemistry. Adhesion molecules and activation markers on tissue eosinophils were analysed by immunofluorescence staining. RESULTS Eotaxin was elevated in serum of two pemphigoid gestationis patients compared with nine healthy pregnant women. Blister fluid contained even higher amounts of eotaxin and in addition IL-5. Eotaxin was mainly expressed in subepidermal tissue in close proximity to eosinophils that expressed high levels of adhesion molecules (CD11b, CD11c, CD18 and CD49d) and the activation marker HLA-DR. CONCLUSIONS High local levels of eotaxin and IL-5 as present in the blister fluid correspond to the high state of activation of the infiltrated eosinophils.
Collapse
Affiliation(s)
- Claudia Günther
- Department of Dermatology, University Hospital Carl Gustav Carus at the Technical University of Dresden, Dresden, Germany
| | | | | | | | | |
Collapse
|
34
|
Penfigoide gestacional: estudio de 9 casos. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2004. [DOI: 10.1016/s0210-573x(04)77340-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
35
|
Aicardi S, Durin L, Dompmartin A, Dreyfus M. [Pemphigoid gestationis and vasculorenal syndrome: a fortuitous association?]. ACTA ACUST UNITED AC 2003; 31:940-2. [PMID: 14623558 DOI: 10.1016/j.gyobfe.2003.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Pemphigoid gestationis is a gestational skin disease usually appearing between the 28th and the 32nd week of amenorrhea. It is a rare vesiculobullous skin disease and the eruption is located around the umbilicus. The diagnosis is made with clinical symptoms but mainly on histologic examination (after skin biopsy) and direct immunofluorescence. One of the main complications is the rate of recurrence. The main treatment is based on topical corticosteroids. The effects of the pemphigoid gestationis are maternal (preterm labor), fetal (intrauterine growth retardation) and neonatal (bullous disease). We report a case of pemphigoid gestationis associated to a gestational hypertensive disorder and we try to rely on both entities.
Collapse
Affiliation(s)
- S Aicardi
- Clinique de gynécologie-obstétrique, CHU de Caen, avenue Georges-Clemenceau, 14033 Caen, France
| | | | | | | |
Collapse
|
36
|
Kroumpouzos G, Cohen LM. Specific dermatoses of pregnancy: an evidence-based systematic review. Am J Obstet Gynecol 2003; 188:1083-92. [PMID: 12712115 DOI: 10.1067/mob.2003.129] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE We conducted an evidence-based systematic analysis of the literature on specific dermatoses of pregnancy. STUDY DESIGN The bibliographic databases MEDLINE and EMBASE were screened for studies and reports in all languages about herpes gestationis, pruritic urticarial papules and plaques of pregnancy, pruritic folliculitis of pregnancy, and prurigo of pregnancy from January 1962 to January 2002. As main index terms, including analogs and derivatives, we used the names of specific dermatoses of pregnancy. Intrahepatic cholestasis of pregnancy, not a primary dermatosis, was included herein because this disorder is associated with pregnancy and its secondary skin manifestations must be differentiated from specific dermatoses of pregnancy. Other sources were abstract books of symposia and congresses, theses, textbooks, monographs, reviews, editorials, letters to the editor, free or rapid communications, and the reference lists from all the articles that were retrieved. All articles selected for inclusion in this review were evaluated critically with regard to their impact factor and evidence-based contribution to this field, as measured by their citation index and impact factor of the journal in which they were published. Approximately 39% of articles met the selection criteria. RESULTS The clinical features and prognosis of the specific dermatoses of pregnancy have been delineated through a number of retrospective and cohort studies. The molecular biologic and immunogenetic properties of herpes gestationis, pruritic urticarial papules and plaques of pregnancy, and intrahepatic cholestasis of pregnancy have been further clarified. A meta-analysis in this review reveals a higher prevalence of multiple gestation pregnancy (11.7%) among patients with pruritic urticarial papules and plaques of pregnancy. Several investigations have unraveled the fetal complications in intrahepatic cholestasis of pregnancy and herpes gestationis. New treatment modalities in intrahepatic cholestasis of pregnancy (cholestyramine, ursodeoxycholic acid) and herpes gestationis (cyclosporin, intravenous immunoglobulin, and tetracyclines postpartum) have shown promise and warrant further evaluation. CONCLUSION During the past few decades, a significant amount of new data has provided new insights into the classification, pathogenesis, treatment, prognosis, and fetal risks that are associated with the specific dermatoses of pregnancy.
Collapse
Affiliation(s)
- George Kroumpouzos
- Division of Dermatology, Department of Medicine, Saint Vincent Hospital at Worcester Medical Center, Newton
| | | |
Collapse
|
37
|
Affiliation(s)
- M M Black
- St. John's Institute of Dermatology, St. Thomas' Hospital, London, UK
| |
Collapse
|