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Pemphigoid Gestationis and adverse pregnancy outcomes: A Literature review. J Gynecol Obstet Hum Reprod 2022; 51:102370. [DOI: 10.1016/j.jogoh.2022.102370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/24/2022] [Accepted: 03/31/2022] [Indexed: 11/23/2022]
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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?
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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
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Huilaja L, Mäkikallio K, Tasanen K. Gestational pemphigoid. Orphanet J Rare Dis 2014; 9:136. [PMID: 25178359 PMCID: PMC4154519 DOI: 10.1186/s13023-014-0136-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/19/2014] [Indexed: 11/15/2022] Open
Abstract
Gestational pemphigoid (pemphigoid gestationis, PG) is a rare autoimmune skin disorder occurring characteristically during pregnancy. Autoantibodies against placental BP180 (also known as BPAG2 or collagen XVII) cause damage to the skin basement membrane, resulting in severe itching and blistering rash over the body and the extremities. The diagnosis of PG is confirmed by immunofluorescence analysis of a skin biopsy, while serum levels of pemphigoid antigen BP180 antibody can be used to assess disease activity. PG with mild symptoms can be treated with topical corticosteroids, while oral corticosteroids are the mainstay in treatment of severe PG. PG usually flares up at the time of delivery, and resolves spontaneously shortly after. However, relapses in subsequent pregnancies are common. As PG has been linked to the risk of prematurity and fetal growth restriction, prenatal monitoring jointly by a dermatologist and an obstetrician is recommended. Mothers should also be informed of the potential risk of re-activation of the disease in subsequent pregnancies and during hormonal contraception.
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Affiliation(s)
- Laura Huilaja
- />Department of Dermatology, Medical Research Center, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Kaarin Mäkikallio
- />Department of Obstetrics and Gynecology, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Kaisa Tasanen
- />Department of Dermatology, Medical Research Center, University of Oulu, Oulu University Hospital, Oulu, Finland
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The utility of C4d immunohistochemistry on formalin-fixed paraffin-embedded tissue in the distinction of polymorphic eruption of pregnancy from pemphigoid gestationis. Am J Dermatopathol 2014; 35:787-91. [PMID: 24061402 DOI: 10.1097/dad.0b013e3182a6b6cc] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Polymorphic eruption of pregnancy (PEP), formerly known as pruritic urticarial papules and plaques of pregnancy, is a dermatosis of pregnancy that must be distinguished from pemphigoid gestationis (PG). Although this differential diagnosis may be possible on routine histology, an additional biopsy for direct immunofluorescence (DIF) is often needed. Recent studies have demonstrated the utility of anti-C4d or anti-C3d antibodies in the diagnosis of bullous pemphigoid (BP) in formalin-fixed paraffin-embedded tissue (FFPE). We investigated the utility of routine immunohistochemistry (IHC) for anti-C4d in FFPE tissue in the specific differential diagnosis of PEP versus PG in known, DIF-proven cases. We performed C4d IHC on PEP (n = 11), PG (n = 8), DIF-proven BP (n = 12), and other common dermatoses (n = 12) that are typically DIF negative. None of the PEP cases (0/11) or the other common dermatoses (0/12) demonstrated C4d positivity at the basement membrane zone. In comparison, 100% of PG cases (8/8) and 83.3% of BP cases (10/12) showed linear C4d immunoreactant deposition along the basement membrane zone. The results demonstrate the potential utility of C4d IHC in FFPE tissue for distinguishing PEP from PG, thus potentially obviating the need of a repeat biopsy for DIF, particularly in C4d-negative cases where there is a low suspicion of PG on both clinical and histological grounds. Also, patients with positive C4d-positive immunoreactivity may also potentially proceed directly to less invasive serological confirmatory testing, such as BP180 NC16a enzyme-linked immunoabsorbent assay.
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Lardenoije CMJG, van de Water M, Mertens HJMM, Gondrie ETCM. Pemphigoid gestationis. BMJ Case Rep 2011; 2011:bcr0120102623. [PMID: 22715180 PMCID: PMC3062810 DOI: 10.1136/bcr.01.2010.2623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 39-year-old woman in the 39th week of her fifth pregnancy presented with severe itching. In recent weeks she had developed an increasingly itchy rash on her trunk and arms. Upon examination we observed multiple erythematous plaques and vesicles. Histological examinations of two skin biopsies confirmed the diagnosis of pemphigoid gestationis. Because the patient's complaints worsened we decided to deliver the baby, and as it was in transverse lie this was by caesarean section. A healthy son without rash was born. Although pemphigoid gestationis occurs in only 1 in 50,000 pregnancies, it is very important to be aware of this condition when a pregnant woman has itching. Not recognising pemphigoid gestationis may lead to inadequate maternal treatment and possible preterm birth and neonatal pemphigoid gestationis.
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Noe MH, Messingham KA, Brandt DS, Andrews JI, Fairley JA. Pregnant women have increased incidence of IgE autoantibodies reactive with the skin and placental antigen BP180 (type XVII collagen). J Reprod Immunol 2010; 85:198-204. [PMID: 20471095 PMCID: PMC5242378 DOI: 10.1016/j.jri.2010.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Revised: 02/04/2010] [Accepted: 03/16/2010] [Indexed: 10/19/2022]
Abstract
BP180 (type XVII collagen) is a transmembrane protein expressed in a variety of cell types. It is also the target of autoantibodies in cutaneous autoimmune disease including bullous pemphigoid and pemphigoid gestationis, a disease unique to pregnancy. The purpose of this study was to determine the prevalence and specificity of cutaneous autoantibodies in a cohort of pregnant women. De-identified sera were collected from pregnant women (n=299) and from non-pregnant controls (n=134). Sera were analyzed by ELISA for the presence of IgG and IgE autoantibodies directed against several cutaneous autoantigens. IgE antibodies against the NC16A domain of BP180 were detected in 7.7% of pregnant women, compared to 2.2% of healthy controls (p=0.01). No increase in total or cutaneous autoantigen specific IgG was seen. Total serum IgE was within the normal range. Full-length BP180 was detected by western immunoblot in epidermal, keratinocyte, placental and cytotrophoblast (CTB) cell lysates. Furthermore, flow cytometry and indirect immunofluorescence confirmed the expression of BP180 on the surface of cultured CTBs. Finally, it was demonstrated that IgE antibodies in the pregnancy sera labeled not only cultured CTBs, but also the placental amnion and cutaneous basement membrane zone using indirect immunofluorescence. We conclude that some pregnant women develop antibodies specific for BP180, and that these autoantibodies are capable of binding both CTB and the placental amnion, potentially affecting placental function.
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Affiliation(s)
- Megan H. Noe
- Department of Dermatology, University of Iowa, Iowa City, IA 52242, USA
| | | | - Debra S. Brandt
- Department of Dermatology, University of Iowa, Iowa City, IA 52242, USA
| | - Janet I. Andrews
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA 52242, USA
| | - Janet A. Fairley
- Department of Dermatology, University of Iowa, Iowa City, IA 52242, USA
- Department of Dermatology, VA Medical Center, Iowa City, IA 52242, USA
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Bánhidy F, Puhó E, Acs N, Czeizel AE. Possible association between maternal recurrent orofacial herpes in pregnancy and a lower rate of preterm birth. J Matern Fetal Neonatal Med 2009; 19:537-42. [PMID: 16966121 DOI: 10.1080/14767050600901044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To study the possible association between orofacial herpes during pregnancy and pregnancy complications including preterm birth and low birth weight, since the results of previous studies are inconsistent. METHOD The population-based large data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities was used; pregnancies in mothers with and without recurrent orofacial herpes were compared. RESULTS. Of 38,151 newborn infants, 572 (1.5%) had mothers with recurrent orofacial herpes during pregnancy, while 37 577 had mothers with no orofacial herpes. Pregnant women with recurrent orofacial herpes had a higher prevalence of severe nausea and vomiting, threatened preterm delivery, and placental disorders but a lower prevalence of preeclampsia. Mothers with recurrent orofacial herpes during pregnancy also had a somewhat longer (0.4 weeks) gestation (adjusted t = 2.7; p = 0.006) and an obviously lower proportion of preterm births (3.5% vs. 9.3%; adjusted POR with 95% CI = 0.42, 0.27-0.65). However, there was no significant difference in the mean birth weight and rate of low birth weight infants between the two study groups. CONCLUSION Recurrent orofacial herpes during pregnancy is associated with a smaller proportion of preterm births.
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Affiliation(s)
- Ferenc Bánhidy
- Second Department of Obstetrics and Gynecology, Semmelweis University, School of Medicine, Budapest, Hungary
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Chi CC, Wang SH, Charles-Holmes R, Ambros-Rudolph C, Powell J, Jenkins R, Black M, Wojnarowska F. Pemphigoid gestationis: early onset and blister formation are associated with adverse pregnancy outcomes. Br J Dermatol 2009; 160:1222-8. [DOI: 10.1111/j.1365-2133.2009.09086.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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]
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Okumus N, Esra Onal E, Turkyilmaz C, Serdaroğlu A, Atalay Y, Oztaş M, Cansu A, Erdem O. A case report of neonatal convulsions due to maternal herpes gestationis. J Child Neurol 2007; 22:488-91. [PMID: 17621536 DOI: 10.1177/0883073807302757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Herpes gestationis is a rarely seen autoimmune vesiculobullous and pruritic dermatosis of pregnancy. Neonatal morbidity associated with maternal herpes gestationis is controversial. The authors report the first case of neonatal convulsion with abnormal electroencephalography findings and transient vesicular eruption due to maternal herpes gestationis.
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Affiliation(s)
- Nurullah Okumus
- Division of Neonatology, Gazi University, School of Medicine, Ankara, Turkey.
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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.
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Affiliation(s)
- Whitney A High
- Department of Dermatology, Pathology, the University of Texas Southwestern Medical Center at Dallas, Texas, USA
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Al-Mutairi N, Sharma AK, Zaki A, El-Adawy E, Al-Sheltawy M, Nour-Eldin O. Maternal and neonatal pemphigoid gestationis. Clin Exp Dermatol 2004; 29:202-4. [PMID: 14987286 DOI: 10.1111/j.1365-2230.2004.01481.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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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.
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Affiliation(s)
- S Aicardi
- Clinique de gynécologie-obstétrique, CHU de Caen, avenue Georges-Clemenceau, 14033 Caen, France
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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.
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Affiliation(s)
- George Kroumpouzos
- Division of Dermatology, Department of Medicine, Saint Vincent Hospital at Worcester Medical Center, Newton
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Shimanovich I, Bröcker EB, Zillikens D. Pemphigoid gestationis: new insights into the pathogenesis lead to novel diagnostic tools. BJOG 2002; 109:970-6. [PMID: 12269691 DOI: 10.1111/j.1471-0528.2002.01016.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Doblas P, Eguiluz I, Barber M, Hijano J, Alonso L, López-Torres E, Narbona I, Cohen I, Luna S, Abehsera M. Trastornos dermatológicos y gestación. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2002. [DOI: 10.1016/s0210-573x(02)77191-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- M S Lin
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
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Laugel V, Escande B, Donato L, Aberkane K, Heid E, Messer J. [Pemphigoid gestationis and bullous lesions in the newborn]. Arch Pediatr 2001; 8:1071-4. [PMID: 11683098 DOI: 10.1016/s0929-693x(01)00585-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pemphigoid gestations is very seldom responsible for cutaneous lesions in newborns through passive transfer of the autoimmune disease from mother to infant. CASE REPORT We report an additional case of a newborn presenting with an extensive but transitory bullous eruption despite the absence of circulating autoantibodies. CONCLUSION Such examples of transplacental pemphigoid are so uncommon that the pathogenic role of IgG autoantibodies is being questioned.
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Affiliation(s)
- V Laugel
- Service de pédiatrie 2, hôpital de Hautepierre, avenue Molière, 67098 Strasbourg, France
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Abstract
The dermatoses of pregnancy can be classified into the following 3 groups: physiologic skin changes in pregnancy, dermatoses and cutaneous tumors affected by pregnancy, and specific dermatoses of pregnancy. Correct diagnosis and classification are essential for the treatment of these disorders, when necessary. Laboratory investigations are required when the diagnosis remains in question despite a careful history and thorough physical examination. A discussion with the pregnant woman about the nature of her skin condition, and the possible fetal risks associated with it, is imperative.
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Affiliation(s)
- G Kroumpouzos
- Department of Dermatology, Boston Medical Center, Boston University School of Medicine, Massachusetts, USA
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Abstract
This article reviews the literature that evaluates pruritic urticarial papules and plaques of pregnancy, herpes gestationis, and intrahepatic cholestasis of pregnancy and their impact on the fetus. Using MEDLINE years 1966 to 1999, a literature search was performed using the terms pregnancy, dermatology, pruritic urticarial papules and plaques of pregnancy, herpes gestationis, and intrahepatic cholestasis of pregnancy. References from the selected papers were then reviewed for additional sources. Thirty-seven studies were reviewed. Both original studies and review articles were included in the sources. The results of each study as originally reported are included to provide the reader the finding of each. The available literature reports no risk with pruritic urticarial papules and plaques of pregnancy; however, the current opinion of most was that there is an increased risk with herpes gestationis and intrahepatic papules and plaques of pregnancy. Although much information is known concerning these unique conditions, a consensus regarding their effect on the fetus has yet to be reached. Pregnancies affected by herpes gestationis and cholestasis of pregnancy should be considered high risk until more definitive evidence can be gained.
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Affiliation(s)
- G B Sherard
- Department of Obstetrics and Gynecology, East Carolina University--Brody School of Medicine, Greenville, North Carolina, USA.
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Powell J, Wojnarowska F, James M, Allott H. Pemphigoid gestationis with intra-uterine death associated with foetal cerebral haemorrhage in the mid-trimester. Clin Exp Dermatol 2000; 25:452-3. [PMID: 11012608 DOI: 10.1046/j.1365-2230.2000.00685-3.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Vaughan Jones SA, Hern S, Nelson-Piercy C, Seed PT, Black MM. A prospective study of 200 women with dermatoses of pregnancy correlating clinical findings with hormonal and immunopathological profiles. Br J Dermatol 1999; 141:71-81. [PMID: 10417518 DOI: 10.1046/j.1365-2133.1999.02923.x] [Citation(s) in RCA: 199] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In 1994 we set up a specialist clinic for pregnancy dermatoses, both to improve the management of pregnant women with skin problems and to enhance our general understanding of the pregnancy dermatoses. This clinic has provided a large database of 200 women which has formed the basis for a prospective study over a 2-year period. In each case the dermatological diagnosis was clearly defined on clinical criteria, with additional help from histopathology and direct immunofluorescence of the skin where appropriate. We have included a number of patients who presented with relatively trivial diagnoses, as this reflects the referral patterns of our midwives, general practitioners and obstetricians within our hospital and local population. Our results show that all patients with specific dermatoses of pregnancy conformed well to the classification established by Holmes and Black in 1983. The role of the sex hormones [oestradiol, human chorionic gonadotrophin (hCG) and cortisol] in polymorphic eruption (PEP) and prurigo of pregnancy was studied in 125 cases and compared with 138 normal healthy pregnant controls. For pruritic folliculitis (PF), serum androgens were measured to establish if these were elevated. Nearly all patients were followed up postpartum, with respect to both maternal and fetal prognosis (some were unfortunately lost to follow-up). Many patients were primiparous (47%) and presented in their third trimester (49%). This study shows a surprisingly high prevalence of eczema during pregnancy. It is possible that earlier cases in the literature termed prurigo of pregnancy may in fact have been eczema, thus explaining the low incidence of prurigo in this study. Hormonal analysis showed a significant reduction in serum cortisol levels in patients with PEP compared with normal pregnant controls (P = 0.03), although hCG and oestradiol showed no differences. Serum androgens were not significantly elevated in patients with PF compared with controls. Birthweight (analysed by the individualized birthweight ratio) was significantly reduced in both the PF and pemphigoid gestationis groups. In the PEP and PF groups there was a male/female infant ratio of 2 : 1, not noted in previous studies. In all cases studied there were no adverse effects either on maternal or fetal outcome as a result of the pregnancy dermatosis. This study indicates that all patients fulfilled the criteria of the previous classification of the specific dermatoses of pregnancy, although we also now highlight the frequency of eczema in pregnancy and speculate as to possible causes. There were no cases of papular dermatitis of pregnancy. We feel that the specialist clinic is an important service which has improved the management of these women and identified areas for further research.
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Affiliation(s)
- S A Vaughan Jones
- St John's Institute of Dermatology, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, U.K
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Abstract
Several reported dermatoses of pregnancy have not survived the scrutiny of time and thus including them in current classification schemes does not serve any useful purpose. This review resolves issues in the existing conflicting literature.
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Affiliation(s)
- J K Shornick
- University of Washington School of Medicine, and Group Health Permanente, Seattle 98112, USA
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Berthier M, Nasimi A, Boussemart T, Cardona J, Oriot D. [Neurologic manifestations in a child of a mother with gestational herpes]. Arch Pediatr 1996; 3:460-2. [PMID: 8763717 DOI: 10.1016/0929-693x(96)86405-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Herpes gestationis in the neonate is usually associated with an increased risk of premature birth and/or low birth weight for gestational age (GA) and sometimes skin lesions. Neurologic manifestations are nos described in these babies. CASE REPORT A boy was born at 35 weeks of GA from a mother who developed skin eruption typical of herpes gestationis. His weight was 2320 g and his height was 46 cm. He had transient respiratory distress syndrome and was given antibiotics due to suspected group B streptococcus infection. He developed on day 3 skin vesiculous eruption which disappeared within 3 days and neurologic manifestations: hypertonia and hyperkinesis, abnormal EEG. The CSF was normal. The manifestations spontaneously disappeared within 5 days. The herpes gestationis factor was present in both mother and infant. CONCLUSION A relationship between the maternal herpes gestationis and neonatal neurologic manifestations is possible; there was no other known causes for the transient neurological disease.
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Affiliation(s)
- M Berthier
- Unité de néonatologie, CHRU de Poitiers, France
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27
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Scott JS, Taylor PV. AUTOIMMUNE DISEASES IN PREGNANCY. Immunol Allergy Clin North Am 1994. [DOI: 10.1016/s0889-8561(22)00347-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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28
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Zurn A, Celebi CR, Bernard P, Didierjean L, Saurat JH. A prospective immunofluorescence study of 111 cases of pruritic dermatoses of pregnancy: IgM anti-basement membrane zone antibodies as a novel finding. Br J Dermatol 1992; 126:474-8. [PMID: 1610688 DOI: 10.1111/j.1365-2133.1992.tb15119.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Since 1981, all pregnant women presenting to our department with a pruritic dermatosis have been investigated by histological and immunopathological techniques. We recruited 111 patients and performed skin histology in 77, 109 direct immunofluorescence tests (DIF), 74 indirect immunofluorescence tests (IIF) and 15 Western blots (WB). We identified: (i) five typical cases of pemphigoid gestationis (PG) (4.5%), corresponding to an incidence of 1/7000 pregnancies. (ii) Five cases without PG but showing circulating anti-BMZ antibodies of IgM type. With the exception of one case, clinical features were homogeneous--occurrence of erythematous papular and/or urticarial lesions on the trunk, and less often, on the limbs between the 32nd and 38th week of pregnancy. Rapid clearance of lesions within a few days was the rule. Whenever performed, DIF was negative and IIF showed circulating anti-BMZ antibodies of IgM type. Western blot studies were negative in these five cases. (iii) One hundred and one cases with negative immunofluorescence tests, considered to be suffering from polymorphic eruption of pregnancy. Our results show the value of systematic immunopathological investigations in pregnant women presenting with a pruritic dermatosis, and raise the possibility of a new entity, as defined by circulating anti-BMZ antibodies of IgM type.
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Affiliation(s)
- A Zurn
- Department of Dermatology, University Hospital, Geneva, Switzerland
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ZURN A, CELEBI C, BERNARD P, DIDIERJEAN L, SAURAT JH. A prospective immunofluorescence study of 111 cases of pruritic dermatoses of pregnancy: IgM anti-basement membrane zone antibodies as a novel finding. Br J Dermatol 1992. [DOI: 10.1111/j.1365-2133.1992.tb11821.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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31
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Abstract
BACKGROUND The potential risks to the fetus in herpes gestationis have long been a controversial subject, but because of the rarity of the disease, have only occasionally been studied. OBJECTIVE The purpose of this study was to determine the incidence of fetal complications in herpes gestationis. METHODS We collected and analyzed the obstetric histories of 74 patients and compared their involved pregnancies with their uninvolved pregnancies. RESULTS There was an obvious tendency for premature delivery associated with herpes gestations. A slight tendency toward small-for-gestational-age newborns associated with herpes gestationis was confirmed, but, perhaps surprisingly, no increase in spontaneous abortions or stillbirths was noted. The use of systemic steroids did not appear to influence risk. CONCLUSION Herpes gestationis is associated with an increase in prematurity and small-for-gestational-age infants.
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Affiliation(s)
- J K Shornick
- University of Connecticut Health Center, Farmington 06030
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Affiliation(s)
- P Karna
- Department of Pediatrics, Michigan State University, Lansing
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Baxi LV, Kovilam OP, Collins MH, Walther RR. Recurrent herpes gestationis with postpartum flare: a case report. Am J Obstet Gynecol 1991; 164:778-80. [PMID: 2003540 DOI: 10.1016/0002-9378(91)90514-r] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A case of herpes gestationis recurring in each pregnancy, with a postpartum flare-up in the last pregnancy, is described. The diagnosis was confirmed by skin biopsy. The first pregnancy ended in a term stillbirth, but there were favorable outcomes in four subsequent pregnancies. Histopathologic examination of the placentas of the last three pregnancies revealed varying grades of villositis. Symptoms improved with oral corticosteroids.
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Affiliation(s)
- L V Baxi
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY 10032
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Abstract
Herpes gestationis is a rare, self limited bullous disease of pregnancy and the post-partum period with a presumed autoimmune basis. It is characterized clinically by pruritic, urticarial and vesiculobullous lesions, histologically by subepidermal vesicle formation, and immunopathologically by deposition of immunoreactants along the basement membrane zone. These features are shared by bullous pemphigoid which suggests that herpes gestationis may be a related entity. Immunoblotting studies have shown that herpes gestationis sera recognize a 180 kD epidermal antigen; in comparison, bullous pemphigoid sera most often detect a 220-240 kD antigen, but a significant number also recognize a 180 kD epidermal antigen, suggesting immunological similarities between these two diseases. Etiology and pathophysiology are not established, but an immunological basis is implicated by the frequent finding of C3 along the basement membrane zone of perilesional skin, the presence of herpes gestationis factor, increased incidence of HLA-DR3 and HLA-DR4, and association with other putative autoimmune diseases. Treatment usually consists of systemic corticosteroids.
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Affiliation(s)
- L H Morrison
- Oregon Health Sciences University, Department of Dermatology, Portland 97201-3098
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Stone OJ. Herpes gestationis--bullae from hormones that cause increased extracellular matrix (autoantibodies to epidermal basement membrane as a secondary phenomenon). Med Hypotheses 1990; 33:11-4. [PMID: 2255268 DOI: 10.1016/0306-9877(90)90077-r] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Herpes gestationis is a bullous skin disease clearly secondary to the hormones of pregnancy and other hormonal influences. It is the result multiple hormones. No one hormone is specific. The hormones increase ground substance viscosity in the skin and this induces edema and bullae formation. Only 10 to 20% of the patients demonstrate IgG formation by indirect immunofluorescence. By direct immunofluorescent studies 30 to 40% of the patients demonstrate deposition of IgG in the basement membrane zone. Other variations of immune factors are present in most cases but they are weak by titers usually present in most so called autoimmune disorders. Many bullous diseases of the skin, including herpes gestationis, are considered autoimmune. It is known that trauma to cells and tissues can induce autoantibodies to form. It is proposed that autoantibodies can form as a secondary phenomenon in bullous skin disorders. The authors who have proposed an autoimmune etiology of herpes gestationis do not attempt to explain the clear association of the disease with the hormones of pregnancy, other female hormones, chorio-carcinoma, or hydatidiform mole.
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37
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Adriaans B, Pullon H, Du Vivier A, Mibashan R. Pemphigoid gestationis and neonatal alloimmune thrombocytopenia. Clin Exp Dermatol 1990; 15:134-6. [PMID: 2189606 DOI: 10.1111/j.1365-2230.1990.tb02050.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A patient whose second, third and fourth pregnancies were complicated by alloimmune thrombocytopenia, developed pemphigoid gestationis after the fourth pregnancy. The infant was delivered by Caesarean section at 34 weeks gestation. The pemphigoid gestationis resolved promptly after a short course of systemic corticosteroids. A possible association between these two uncommon conditions is discussed.
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Affiliation(s)
- B Adriaans
- Department of Dermatology, King's College Hospital, Denmark Hill, London, UK
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38
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Frumkin A. Herpes gestationis, umbilical cord knot, and fetal death. J Am Acad Dermatol 1989; 21:812-3. [PMID: 2681286 DOI: 10.1016/s0190-9622(89)80286-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Abstract
Transplacentally transferred dermatoses (TTDs) are cutaneous diseases that are transmitted from mother to fetus through the placental circulation. The uniqueness of the maternal-placental-fetal interaction provides many helpful opportunities to enhance our understanding of the pathogenesis and course of these diseases.
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Affiliation(s)
- P A Krusinski
- Division of Dermatology, University of Vermont College of Medicine, Burlington
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40
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Kelly SE, Fleming S, Bhogal BS, Wojnarowska F, Black MM. Immunopathology of the placenta in pemphigoid gestationis and linear IgA disease. Br J Dermatol 1989; 120:735-43. [PMID: 2667614 DOI: 10.1111/j.1365-2133.1989.tb01371.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We have investigated the immunopathology of the placenta in bullous diseases by studying the deposition of immune complexes and expression of MHC class II subregion products by immunohistological methods. Placentae from seven patients with pemphigoid gestationis (PG) and two patients with linear IgA disease were studied. In PG immune complexes containing IgGI and C3 were identified in six cases. In linear IgA disease IgAI containing immune complexes were found in both cases. Placentae from patients with PG showed aberrant expression of MHC Class II products. This was not seen in the placentae from patients with linear IgA disease. In PG there was incoordinate expression of the subregion products, DP and DR being more extensively and consistently expressed than DQ. These results and previous immunogenetic studies suggest that PG may be unique among organ specific autoimmune disease, the autoantibodies forming during an allogenic response rather than target cells behaving as antigen presenting cells.
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Affiliation(s)
- S E Kelly
- Dowling Skin Unit, St Thomas' Hospital, London, U.K
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41
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Gawkrodger DJ. Cutaneous autoimmunity. Autoimmunity 1989; 3:213-33. [PMID: 2491629 DOI: 10.3109/08916938909099018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- D J Gawkrodger
- University Department of Dermatology, Royal Hallamshire Hospital, Sheffield, UK
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42
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Black MM. The specific dermatoses of pregnancy: a reappraisal. Australas J Dermatol 1988; 29:131-4. [PMID: 3272120 DOI: 10.1111/j.1440-0960.1988.tb00384.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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43
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Alcalay J, Wolf JE. Pruritic urticarial papules and plaques of pregnancy: the enigma and the confusion. J Am Acad Dermatol 1988; 19:1115-6. [PMID: 3204181 DOI: 10.1016/s0190-9622(98)80006-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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44
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Brampton WJ. The end of clinical freedom? West J Med 1988. [DOI: 10.1136/bmj.297.6660.1408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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45
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Szanto S. Points: Starving outpatients. West J Med 1988. [DOI: 10.1136/bmj.297.6660.1408-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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46
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Hutchison GL, McMurdo MET. Points: Monitoring the acute phase response. West J Med 1988. [DOI: 10.1136/bmj.297.6660.1408-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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47
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Mackie DS. Points: Health and the ozone layer. West J Med 1988. [DOI: 10.1136/bmj.297.6660.1408-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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48
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Tomlin PJ, Salmon M, Darnell R, Dryburgh WA, Jacobs H, Bousquet P, Loizon L. Disciplining doctors. West J Med 1988. [DOI: 10.1136/bmj.297.6660.1407-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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49
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Charles-Holmes R. Points: The quest for youth and blistering in pregnancy. West J Med 1988. [DOI: 10.1136/bmj.297.6660.1408-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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50
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Kelly SE, Bhogal BS, Wojnarowska F, Black MM. Expression of a pemphigoid gestationis-related antigen by human placenta. Br J Dermatol 1988; 118:605-11. [PMID: 3293646 DOI: 10.1111/j.1365-2133.1988.tb02560.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We studied the antigen binding of sera from 25 patients with pemphigoid gestationis (PG) using skin and amnion as substrates in an indirect immunofluorescence technique. In addition, skin was studied after prior incubation with I M NaCl which allows BMZ cleavage through the lamina lucida. Linear BMZ staining was obtained with sera from patients with PG using human amnion as substrate. This was seen with both full-term and second trimester placentae, but not with first trimester placentae. In NaCl incubated skin all sera bound to the epidermal aspect of the separated tissue. The pattern of staining in skin, chemically split skin and amnion was identical to that previously seen with the sera of patients with bullous pemphigoid suggesting that the antigen against which circulating anti-BMZ antigens are directed may be the same in the two conditions.
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Affiliation(s)
- S E Kelly
- Department of Dermatology, Slade Hospital, Headington, Oxford, U.K
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