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Xie F, Lehman JS, Baban F, Johnson EF, Theiler RN, Todd A, Davis DMR. Pemphigoid gestationis and polymorphic eruption of pregnancy: treatment and outcomes in a retrospective cohort study. Int J Dermatol 2024; 63:e29-e32. [PMID: 37916499 DOI: 10.1111/ijd.16884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 10/01/2023] [Accepted: 10/12/2023] [Indexed: 11/03/2023]
Affiliation(s)
- Fangyi Xie
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Julia S Lehman
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Farah Baban
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Division of Anatomic and Clinical Pathology, Mayo Clinic, Rochester, MN, USA
| | - Emma F Johnson
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Regan N Theiler
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Austin Todd
- Department of Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Dawn M R Davis
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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Liu Y, Yuan J, Xia Y, Du X, Geng S. A case of pemphigoid gestationis successfully treated with dupilumab. J Eur Acad Dermatol Venereol 2023; 37:e1164-e1165. [PMID: 37147906 DOI: 10.1111/jdv.19171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/26/2023] [Indexed: 05/07/2023]
Affiliation(s)
- Yanting Liu
- Department of Dermatology, Northwest Hospital, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jingyi Yuan
- Department of Dermatology, Northwest Hospital, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yumin Xia
- Department of Dermatology, Northwest Hospital, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xueshan Du
- Department of Dermatology, Northwest Hospital, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Songmei Geng
- Department of Dermatology, Northwest Hospital, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Abstract
Pruritus in pregnancy is a common and burdensome symptom that may be a first sign of a pregnancy-specific pruritic disease (atopic eruption of pregnancy, polymorphic eruption of pregnancy, pemphigoid gestationis, and intrahepatic cholestasis in pregnancy) or a dermatosis coinciding with pregnancy by chance. Despite its high prevalence, pruritus is often underrated by physicians, and data regarding the safety profiles of drugs for pruritus are very limited. In this review, we illustrate the epidemiology, possible pathophysiology, clinical characteristics, and diagnostic workup of various pregnancy-related diseases and discuss antipruritic treatments. The prevalence of pruritus in pregnancy demonstrates the importance of symptom recognition and the need for an holistic approach, taking into account both the potential benefits for the patient and the potential risks to the fetus.
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Affiliation(s)
- Aleksandra A Stefaniak
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Von Esmarch Str 58, 48149, Münster, Germany.
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wrocław, Poland.
| | - Manuel P Pereira
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Von Esmarch Str 58, 48149, Münster, Germany
| | - Claudia Zeidler
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Von Esmarch Str 58, 48149, Münster, Germany
| | - Sonja Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Von Esmarch Str 58, 48149, Münster, Germany
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Patel PM, Jones VA, Murray TN, Amber KT. A Review Comparing International Guidelines for the Management of Bullous Pemphigoid, Pemphigoid Gestationis, Mucous Membrane Pemphigoid, and Epidermolysis Bullosa Acquisita. Am J Clin Dermatol 2020; 21:557-565. [PMID: 32180161 DOI: 10.1007/s40257-020-00513-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Autoimmune blistering disease management can be challenging as treatment modalities vary greatly and no single standard of care exists. We consolidated the recommendations of international management guidelines in order to provide optimal management suggestions to physicians. A comprehensive literature search in PubMed/MEDLINE for published blistering disease management guidelines and consensus statements was conducted in November 2019. Search terms included "guideline or guidelines" or "consensus" and "pemphigoid" or "autoimmune blistering disease" or "epidermolysis bullosa acquisita". We included guidelines from established dermatologic societies and expert consensus groups. We excluded literature reviews, guidelines established by an association without dermatologists, or those specific to a single treatment. Guidelines in all languages were considered. Eleven guidelines from dermatologic associations and consensus groups meeting our inclusion criteria were selected. Several differences between recommendations, most notably when to introduce adjuvants for refractory disease, were found in bullous pemphigoid. In mucous membrane pemphigoid, treatment was directed to the sites involved and managed with systemic corticosteroids and immunosuppressants/biologics. There was no universal consensus on the first-line treatment for epidermolysis bullosa acquisita, but a combination of immunosuppressive, anti-inflammatory, and anti-neutrophil therapy was utilized. Comparison of the management guidelines revealed underrepresentation of guidelines from developing nations and key differences between the management styles among dermatologists from Europe and Asia. We attribute these discrepancies to the time elapsed between guidelines, regional differences, and demands of the local healthcare systems.
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Affiliation(s)
- Payal M Patel
- Department of Dermatology, University of Illinois at Chicago, 808 S. Wood St, RM377, Chicago, IL, 60612, USA
| | - Virginia A Jones
- Department of Dermatology, University of Illinois at Chicago, 808 S. Wood St, RM377, Chicago, IL, 60612, USA
| | - Taryn N Murray
- Department of Dermatology, University of Illinois at Chicago, 808 S. Wood St, RM377, Chicago, IL, 60612, USA
| | - Kyle T Amber
- Department of Dermatology, University of Illinois at Chicago, 808 S. Wood St, RM377, Chicago, IL, 60612, USA.
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Santos-Alarcón S, Benavente-Villegas C, García-Briz I, Moneva-Léniz M, Sanchis-Sánchez C, Mateu-Puchades A. Urticarial Lesions in a Pregnant Woman. Acta Dermatovenerol Croat 2018; 26:71-72. [PMID: 29782306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Dear Editor, Gestational pemphigoid (GP) is a rare autoimmune bullous dermatosis in pregnancy. GP usually occurs during the second or third month of pregnancy. It clinically manifests as the development of either early-onset urticarial lesions or late-onset subepidermal blisters that may linger for weeks or even months. Herein we report the case of a 45-year-old woman with the distinctive clinical onset of GP. A forty-five-year-old woman, gravida I, para 0, at 27 weeks gestation, was referred for evaluation to our Department with an extensive pruritic eruption that had developed over the previous 7 days. The lesions had first appeared on the proximal thighs and extended progressively to the abdomen. On physical examination, numerous round urticarial plaques of approximately 1 cm in diameter were noted on her abdomen, involving the periumbilical area. Her thighs and back were also affected (Figures 1 and 2). The palms and soles were spared. No mucosal involvement was seen. The patient medical history was unremarkable, and she denied use of any other medications or herbal remedies at the time the symptoms started or since. No other symptoms but pruritus were referred. Laboratory studies, including complete blood cell count, coagulation tests, and renal and hepatic function were all normal. A punch biopsy was taken from an urticarial plaque and stained with hematoxylin and eosin. Histological examination found spongiosis in combination with an intraepidermal eosinophilic infiltrate, without the development of blisters (Figure 3). Direct immunofluorescence of perilesional skin showed linear deposition of complement (C3) along the basement membrane zone (Figure 4). Serum antibody titers for BP180NC16a were detected by enzyme-linked immunosorbent assay (ELISA). We established a diagnosis of gestational pemphigoid. Our patient was treated with systemic glucocorticoids, no blisters developed, and lesions cleared 8 weeks after delivery. The newborn girl did not developed neonatal gestational pemphigoid. Gestational pemphigoid, originally misnamed herpes gestationis, is a rare autoimmune bullous dermatosis in pregnancy. Single cases have been also described in patients with molar pregnancies and trophoblastic tumors (1). Its etiology is based in the development of autoantibodies against the fetoplacental unit, triggering an autoimmune response against both skin and amnion hemidesmosomal proteins, mainly BP180, but also BP230 and type VII collagen. An association with HLA-DR3 and HLA-DR4 has been described (2). GP usually occurs during the second or third month of pregnancy, but it may appear at any time during pregnancy or puerperium. In the vast majority of cases, symptoms alleviate a few weeks before delivery, but they reemerge at the time of delivery. Recurrences are frequent in following pregnancies, with an earlier onset and more severe symptoms, and may occur during subsequent menstruations or hormonal contraceptive use (1). GP clinically consists of the development of either early-onset urticarial lesions or late-onset subepidermal blisters that mat linger for weeks or even months. They generally appear on the abdomen, specifically in the periumbilical area, with posterior widespread extension to proximal limbs. Facial and mucosal lesions are uncommon (1). Histopathological studies are necessary to establish the diagnosis. These findings vary depending on the stage and severity of the disease and include subepidermal blisters, papillary dermal edema, eosinophilic spongiosis, and a polymorphous perivascular inflammatory cell infiltrate with a predominance of eosinophils. Direct immunofluorescence of perilesional skin shows a linear deposition of C3 along the basement membrane zone in all cases. IgG deposits can also be seen (3). These deposits are located within the lamina lucida and localized to the proximal part of anchoring filaments of the epidermal fragment of salt-split skin (4). Moreover, immunoblot and ELISA of the NC16a domain of BP180 RP are highly sensitive diagnostic methods in GP (5). The aim of treatment is to alleviate the pruritus and prevent formation of new blisters. Topical corticosteroids and oral antihistamines may be used in mild cases. Systemic corticosteroids are the treatment of choice in moderate to severe cases. Other treatments that have been used are cyclophosphamide, dapsone, gold, methotrexate, and plasmapheresis (5).
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Affiliation(s)
- Sergio Santos-Alarcón
- Sergio Santos-Alarcon, MD, Department of Dermatology, , Hospital Universitario Doctor Peset, Avinguda Gaspar Aguilar Nº 90, 4601 Valencia, Spain;
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Affiliation(s)
- Nadia Shad
- University Hospital Lewisham, London, UK
| | - Masud Haq
- Tunbridge Wells Hospital, Tunbridge Wells, UK
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Guerra L, Mazzanti C, Calabresi V, De Luca N, Zambruno G, Di Zenzo G. Pemphigoid Gestationis Complicating an Egg Donation Pregnancy. Acta Derm Venereol 2016; 96:695-6. [PMID: 26608214 DOI: 10.2340/00015555-2303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Liliana Guerra
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS, 00167 Rome, Italy.
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8
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Seidel R, Lavi N, Chipps L. Pemphigoid Gestationis: A Case Report and Review of Management. J Drugs Dermatol 2015; 14:904-907. [PMID: 26267738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Pemphigoid gestationis (PG) is a rare pruritic autoimmune dermatosis associated with several adverse fetal outcomes. An appropriate pharmacotherapy regimen reduces these risks while also providing symptomatic relief. CASE A woman in her second trimester presented with an intensely pruritic vesiculobullous rash diagnosed as PG. She was started on prednisone and gradually tapered to an appropriate maintenance dose until her uncomplicated delivery of a full-term healthy newborn. CONCLUSION Proper management of PG requires a suitable pharmacotherapy regimen, close observation, and collaboration with a multi-disciplinary treatment team. These steps are crucial to reduce maternal morbidity, lessen fetal risk, and adequately prepare for the possibility of unfavorable obstetric outcomes.
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Huilaja L, Mäkikallio K, Hannula-Jouppi K, Väkevä L, Höök-Nikanne J, Tasanen K. Cyclosporine treatment in severe gestational pemphigoid. Acta Derm Venereol 2015; 95:593-5. [PMID: 25519774 DOI: 10.2340/00015555-2032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Gestational pemphigoid, a rare autoimmune skin disease typically occurring during pregnancy, is caused by autoantibodies against collagen XVII. Clinically it is characterised by severe itching followed by erythematous and bullous lesions of the skin. Topical or oral glucocorticoids usually relieve symptoms, but in more severe cases systemic immunosuppressive treatments are needed. Data on immunosuppressive medication controlling gestational pemphigoid are sparse. We report 3 intractable cases of gestational pemphigoid treated with cyclosporine.
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Affiliation(s)
- Laura Huilaja
- Deparment of Dermatology, Medical Research Center, University of Oulu, Oulu University Hospital, P.B. 20, 90029 OYS, FIN-90220 Oulu, Finland.
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Abstract
Skin manifestations during pregnancy are common and diversified. This review will focus on the most important entities to be recognized by obstetricians. These are, on the one hand, physiological changes, where unnecessary investigations should be avoided, and on the other, the specific dermatoses of pregnancy. These develop electively in pregnancy, and they are currently grouped into three disorders: polymorphic eruption of pregnancy, atopic eczema of pregnancy, and pemphigoid gestationis. Arguments for recognition of these are presented including detection of anti-BP180 antibodies. Follow-up and treatment depend on the precise diagnosis. Risks in fetal prognosis may occur in rare pemphigoid gestationis cases.
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Affiliation(s)
- Boutros Soutou
- Faculté de médecine, Universite saint-Joseph, 11-5076 Riad el Solh, Beirut, Lebanon; Centre Hospitalier du Nord, 100 Jdeidet Zgharta, Lebanon.
| | - Sélim Aractingi
- Faculté de médecine, Paris 5 descartes, Service de Dermatologie, Hôpital Cochin Tarnier, 89, rue d'Assas, 75006 Paris, France; Equipe Cellules souches foetales, Inserm UMR S 938 & UPMC, CDR St Antoine, 27, rue de Chaligny, 75012 Paris, France.
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11
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Moreno-Diaz JA, Paredes-Solis V, Martínez-Chagolla BDJ, Sereno-Coló JA. [Herpes gestationis. A case report]. Ginecol Obstet Mex 2014; 82:697-704. [PMID: 25510061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Case report. 21 years old woman with 30 week pregnancy, complicated by a 3 month multitreated skin condition, who was referred to General Hospital Morelia, with probable diagnosis of Kapossi sarcoma and sus- pected HIV. She presented with exulcerations involving the palate, lips, chest, abdomen, back and extremities. The lesions were, itchy and painful, with thick yellowish secretion, accompanied by dysphagia to solid foods. Laboratory results showed normochromic normocytic anemia, elevation of ESR, hypocalcaemia, increased PCR, results in alterations in various TORCH listing, HIV negative. The biopsy of a lesion of the forearm reported histological changes consistent with herpes, subsequently confirmed by direct immunofluorescence. Liquid aspiration secretion of one of the lesions reported coagulase negative staphylococcus sp and Enterobacter cloacae. The final diagnosis was 30 weeks pregnant women with gestational herpes complicated by pyogenic infection of the lesions, discarding infection with HIV and found positive for IgG to toxoplasma, rubella, cytomegalovirus and herpes virus.
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12
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Hjortø S, Skov L, Lykke JA. [Obstetric dermatoses]. Ugeskr Laeger 2014; 176:V05130346. [PMID: 25294508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The specific dermatoses of pregnancy are rare and consist of pemphigoid gestationis (PG), intrahepatic cholestasis of pregnancy (ICP), polymorphic eruption of pregnancy and atopic eruption of pregnancy. The dermatoses are characterized by pruritus, and they are important to recognize since PG and ICP increase the risk of prematurity, fetal distress and stillbirth. Diagnosis is based on medical history, morphology, blood sample and biopsy. The dermatoses are treated with respectively ursodeoxycholic acid (in case of ICP) and steroids. Breast-feeding is recommended and induction of labour is not normally indicated.
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Affiliation(s)
- Sofie Hjortø
- Gynækologisk/Obstetrisk Afdeling, Roskilde Sygehus, Køgevej 7-13, 4000 Roskilde.
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Yang B, Wang C, Wu M, Du D, Yan X, Zhou G, Zhang F. A case of pemphigoid gestationis with concurrent IgG antibodies to BP180, BP230 and type VII collagen. Australas J Dermatol 2014; 55:e15-8. [PMID: 23082779 DOI: 10.1111/j.1440-0960.2012.00960.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Accepted: 08/25/2012] [Indexed: 12/23/2022]
Abstract
A 22-year-old primigravida had a pruritic, erythematous, bullous eruption on the skin during the 26th week of gestation. After delivery the eruption flared up. The diagnosis of pemphigoid gestationis was confirmed based on histopathological and immunofluorescence findings. The result of immunoblotting showed IgG autoantibodies which reacted against BP230 in epidermal extracts and 290 kDa type VII collagen in dermal extracts. The BP180 antibodies were also detected by an enzyme-linked immunosorbent assay BP180NC16a diagnosis kit. Pulsed corticosteroid and cyclophosphamide resulted in a favourable response at the acute stage. The patient was cured in 2 years. The analysis of the patient's autoantibodies provides strong evidence for the involvement of epitope spreading in her autoimmune disease.
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Affiliation(s)
- Baoqi Yang
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Provincial Academy of Medical Science; Shandong Provincial Key Lab for Dermatovenereology
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Inani K, Meziane M, Bouyahyaoui Y, Mernissi FZ, Sekal M, Harmouch T, Amarti A, Rachade M, Melhouf MA. [Choriocarcinoma: a hidden face of pemphigoid gestationis]. ACTA ACUST UNITED AC 2014; 42:357-9. [PMID: 24411341 DOI: 10.1016/j.gyobfe.2013.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Indexed: 11/18/2022]
Abstract
Gestationis pemphigoid is an autoimmune subepidermal blistering dermatosis occurring predominantly in pregnancy, more seldom in early puerperium, and exceptionally in post-abortion. The association of gestationis pemphigoid with choriocarcinoma is extremely rare. We report this association in a patient of 35 years in which the diagnosis of gestationis pemphigoid was made on clinical, histological and immunological criteria, and the one of choriocarcinoma was made on clinical, biological radiological and histological criteria. Through this article, we put the item on this association reported for the first time in post-abortion.
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Affiliation(s)
- K Inani
- Service de dermatologie, CHU Hassan II Fès, BP 1835, Atlass, Fès, Maroc.
| | - M Meziane
- Service de dermatologie, CHU Hassan II Fès, BP 1835, Atlass, Fès, Maroc
| | - Y Bouyahyaoui
- Service de dermatologie, CHU Hassan II Fès, BP 1835, Atlass, Fès, Maroc
| | - F-Z Mernissi
- Service de dermatologie, CHU Hassan II Fès, BP 1835, Atlass, Fès, Maroc
| | - M Sekal
- Service d'anatomopathologie, CHU Hassan II Fès, BP 1835, Atlass, Fès, Maroc
| | - T Harmouch
- Service d'anatomopathologie, CHU Hassan II Fès, BP 1835, Atlass, Fès, Maroc
| | - A Amarti
- Service d'anatomopathologie, CHU Hassan II Fès, BP 1835, Atlass, Fès, Maroc
| | - M Rachade
- Service de gynécologie obstétrique, CHU Hassan II Fès, BP 1835, Atlass, Fès, Maroc
| | - M-A Melhouf
- Service de gynécologie obstétrique, CHU Hassan II Fès, BP 1835, Atlass, Fès, Maroc
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15
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Stevenson ML, Marmon S, Tsou H, Boyd KP, Robinson MR, Meehan SA, Pomerantz R. Pemphigoid gestationis. Dermatol Online J 2013; 19:20715. [PMID: 24365006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 12/16/2013] [Indexed: 06/03/2023] Open
Abstract
We present a 21-year-old primigravida woman with a several-week history of pruritic, edematous, targetoid plaques that appeared initially on the abdomen, flanks, and legs and that progressed to involve the inner aspects of the upper arms and lateral aspects of the chest. The histopathologic findings showed perivascular and interstitial dermatitis with eosinophils and vacuolar changes with linear C3 deposition at the basement-membrane zone on direct immunofluorescence study. A diagnosis of pemphigoid gestationis was made. Pemphigoid gestationis is a rare, bullous dermatosis of pregnancy that may be associated with prematurity and small-for-gestational age birth weights. The diagnosis is often made with direct immunofluorescence studies of perilesional skin. Oral glucocorticoids remain the gold standard of therapy in moderate-to-severe cases. The edematous papules and plaques of pemphigoid gestationis may be particularly difficult to distinguish from polymorphic eruption of pregnancy; therefore, immunofluorescence studies are prudent. Prompt recognition and appropriate management may reduce morbidity of this disease, which often recurs with subsequent pregnancies.
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Bergman H, Melamed N, Koren G. Pruritus in pregnancy: treatment of dermatoses unique to pregnancy. Can Fam Physician 2013; 59:1290-1294. [PMID: 24336540 PMCID: PMC3860924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
QUESTION Some of my pregnant patients complain about pruritus. Are there conditions in pregnancy that present with pruritus that might put the mother or fetus at risk? ANSWER Although most cases of pruritus can be attributed to itchy dry skin, there are conditions unique to pregnancy that involve pruritus as a leading symptom. These include pemphigoid gestationis, pruritic urticarial papules and plaques of pregnancy, intrahepatic cholestasis of pregnancy, and atopic eruption of pregnancy. These conditions are associated with severe pruritus and some might be associated with adverse fetal outcomes. Clinical history and physical examination are the most important diagnostic clues when evaluating pruritus in pregnancy.
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Gras J, Morin AS, Caux F, Mekinian A, Fain O. [Pemphigoid gestationis]. Rev Prat 2013; 63:1208. [PMID: 24422286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Julien Gras
- Service de médecine interne, hôpital Jean Verdier (AP-HP), université Paris 13, 93140 Bondy, France
| | - Anne-Sophie Morin
- Service de médecine interne, hôpital Jean Verdier (AP-HP), université Paris 13, 93140 Bondy, France
| | - Frédéric Caux
- Service de dermatologie, hôpital Avicenne (AP-HP), université Paris 13, 93000 Bobigny, France
| | - Arsène Mekinian
- Service de médecine interne, hôpital Jean Verdier (AP-HP), université Paris 13, 93140 Bondy, France
| | - Olivier Fain
- Service de médecine interne, hôpital Jean Verdier (AP-HP), université Paris 13, 93140 Bondy, France
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Kucukunal A, Altunay I, Sakiz D. Pemphigoid gestationis with postpartum flare-up: a case report. J Reprod Med 2013; 58:545-549. [PMID: 24568052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Pemphigoid gestationis (PG), also known as herpes gestationis, is an uncommon autoimmune blistering disease that almost always occurs in the third trimester of pregnancy. The sudden emergence of the disease, its clinical appearance and the course create great stress on the pregnant woman and the fetus. The disease has been associated with premature delivery and small-for-gestational-age infants. Corticosteroids remain the mainstay of therapy. CASE A pregnant woman presented with a diffuse blistering and intensely pruritic urticarial plaques that occurred periumbilically and spread to the rest of the body. We report a well-documented case of PG and an overview of the current understanding of the disease. CONCLUSION A multidisciplinary approach for diagnosis, treatment and course of the disease from both dermatologic and gynecologic viewpoints is suggested.
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Affiliation(s)
- Asli Kucukunal
- Department of Dermatology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.
| | - Ilknur Altunay
- Department of Dermatology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Damlanur Sakiz
- Department of Dermatology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
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19
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Guldrís EM, Couceiro E. Pemphigoid gestationis. J Obstet Gynaecol Can 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] [What about the content of this article? (0)] [Affiliation(s)] [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
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Rassai S, Pazyar N, Alavi SM, Kazerouni A, Feily A. Pemphigoid gestationis: a retrospective study in southwest Iran. Acta Med Iran 2013; 51:408-410. [PMID: 23852847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Indexed: 06/02/2023] Open
Abstract
Pemphigoid gestationis (PG) is a rare autoimmune bullous dermatosis of pregnancy usually presents in the second or third trimester. It is characterized by pruritic, urticarial plaques with the development of tense vesicles and bullae within the lesions. Pathogenesis of PG is not fully established, however, most patients develop circulating autoantibodies targeting the bullous pemphigoid (BP) 180 antigen. The aim of this work is to draw a profile of the epidemiology, clinical aspects, treatment and evolution of the disease by studying hospital series. We retrospectively investigated the 13 patients who were diagnosed with PG based on hospital data at the Referral Center of Southwest Iran located in Ahvaz city between March 2002 and March 2011. The age of onset was 21 to 40 years (mean age: 27.5 years). The onset of the disease occurred in the second trimester of pregnancy in 6 patients and in the third trimester of pregnancy in 4 patients. One patient had a flare up of disease during the first trimester and two out of cases in puerperium period. In all cases, pruritus was the first symptom, followed by an erythematous vesiculobullous eruption. The diagnosis of PG was confirmed by skin biopsy. Ten out of the patients treated with oral corticosteroids (0.5-1 mg/kg/day), one of the patients underwent oral corticosteroids plus topical glucocorticoid and the last patient treated with topical glucocorticoid. PG remains a rare dermatosis of pregnancy. Our series had two particularities compared to other studies: high frequency in primigravida and the frequent involvement of the face. Additionally our study demonstrated that improvement could occur faster and provide acceptable management if the treatment of the patients would be implemented sooner.
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Affiliation(s)
- Sima Rassai
- Department of Dermatology, Jundishapur University of Medical Sciences, Ahvaz, Iran
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Huilaja L, Mäkikallio K, Tasanen K. [Gestational pemphigoid]. Duodecim 2013; 129:731-738. [PMID: 23720942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Gestational pemphigoid is a rare pruritic bullous pregnancy associated dermatosis caused by autoantibodies against placental and dermal collagen XVII. Clinically, it is characterized by severe pruritus and blisters on abdominal skin and extremities. Immunofluorescence analysis of perilesional skin is used in the diagnostics and maternal serum BP180-levels reflect the disease activity. Topical steroids and antihistamins usually relieve mild symptoms, but in severe cases oral corticosteroid is the drug-of-choice. Spontaneous recovery is common after parturition but this disease typically recurs in the following pregnancies. Due to the associated risk of prematurity and fetal growth restriction, prenatal monitoring jointly by a dermatologist and an obstetrician is recommended.
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Affiliation(s)
- Laura Huilaja
- OYS, medisiininen tulosalue, ihotautien klinikka ja Oulun yliopisto, ihotautien klinikka, kliinisen lääketieteen laitos
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Lozinski A, Baum S, Sagi L, Volkov A, Trau H, Barzilai A. [Rituximab (Mabthera) for treatment of rare autoimmune bullous skin disorders]. Harefuah 2012; 151:562-606. [PMID: 23316661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Autoimmune bullous skin disorders are characterized by a severe and potentially lethal course and may require aggressive long-term treatment with systemic corticosteroids and other immunosuppressive drugs, which can lead to serious adverse events. Recently, anti-CD20 antibody, Rituximab, was reported to be beneficial as an adjuvant therapy in these diseases. Herein, we present 2 case reports of patients suffering from resistant rare diseases from the aforementioned spectrum: linear IgA dermatosis and Pemphigoid gestationis. The patients were successfully treated with Rituximab (Mabthera). This is one of the first reports of this kind of treatment for these rare life-threatening diseases. These case reports emphasize the role of Rituximab as a crisis therapy in autoimmune blistering diseases.
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Affiliation(s)
- Alina Lozinski
- Department of Dermatology, Sheba Medical Center, Tel Hashomer, Ramat Gan.
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Westermann L, Hügel R, Meier M, Weichenthal M, Zillikens D, Gläser R, Schmidt E. Glucocorticosteroid-resistant pemphigoid gestationis: successful treatment with adjuvant immunoadsorption. J Dermatol 2012; 39:168-71. [PMID: 22379622 DOI: 10.1111/j.1346-8138.2011.01376.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 40-year old prima para presented with multiple urticaria-like plaques and severe pruritus 2 weeks prior to giving birth by cesarean section. Three days after birth, the disease flared up and tense blisters appeared on hands, lower arms and feet. Based on the clinical presentation, direct immunofluorescence microscopy, complement binding test and detection of high levels of circulating anti-BP180 antibodies, the diagnosis of pemphigoid gestationis was established. Despite treatment with class IV topical corticosteroid and prednisolone p.o. up to 60 mg/day, both skin lesions and severe pruritus progressed accompanied by increasing anti-BP180 antibody serum levels. In order to continue breast feeding, the prednisolone dose could not be further increased and 10 immunoadsorptions over 4 weeks were performed. During this period, skin lesions cleared rapidly, pruritus subsided and BP180-specific serum autoantibodies decreased by 99.5% allowing the reduction of prednisolone to 7.5 mg/day. We conclude that immunoadsorption is an effective and safe adjuvant therapeutic option for severe pemphigoid gestationis.
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Affiliation(s)
- Lilia Westermann
- Department of Dermatology, University of Lübeck, Lübeck, Germany
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Abstract
Pemphigoid gestationis is a rare autoimmune subepidermal bullous dermatosis that occurs during pregnancy and postpartum. Diagnosis is made on the basis of the presence of a subepidermal vesicle on routine histologic examination and of linear deposition of complement along the basement membrane zone of perilesional skin. The disorder is accompanied by severe pruritus and polymorphous bullous skin lesions. Clinical diagnosis is confirmed by histology and positive cutaneous immunofluorescence and immunoelectron microscopy tests (linear deposition of C3, with or without immunoglobulin G, along the basement membrane zone, within the lamina lucida, and localized to the proximal part of anchoring filaments of the epidermal fragment of salt-split skin). Enzyme-linked immunosorbent assay for pemphigoid gestationis antibody (BP180) is commercially available. If local treatment fails, systemic corticosteroid therapy should be administered. Oral corticosteroids are the therapeutic mainstay in pregnancy and postpartum. The prognosis is good for mother and child, except that there is a risk of preterm delivery and of moderate fetal growth restriction. Recurrence is possible during subsequent pregnancies. There is no significant maternal morbidity or mortality.
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Affiliation(s)
- Jasna Lipozenčić
- Department of Dermatology and Venereology, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Croatia.
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Abstract
BACKGROUND Pemphigoid gestationis (PG) is a rare auto-immune bullous disease occurring in one pregnant woman over 20,000 to 50,000. OBJECTIVE Review of literature about physiopathology, immunological diagnosis and treatment of PG. METHODS Research on Medline and Embase database without any time limit until April 2010. Because of the lack of randomized therapeutic trials in PG, retrospective series and case reports have been analyzed. RESULTS PG is due to auto-antibodies directed against BP180 secondary to a mother-fetus immunological tolerance breaking. Blister formation results from a complex mechanism involving TH2 lymphocytes, cytokines and polymorphonuclear cells. Clinically, the disease is characterized by a pruritic, more or less extensive erythemato-papulous eruption. The presence of vesicles and/or blisters is inconstant but evocative. Recovery occurs generally in a few weeks after delivery but relapses are frequent in subsequent pregnancies. Combined oral contraception may also trigger flares of the disease. Diagnosis is confirmed by direct immunofluorescence showing linear C3±IgG deposits in the dermal-epidermal junction. ELISA BP180-NC16A method is very sensitive to detect circulating auto-antibodies. Fetal prognosis is good, but early onset in 1(st) or 2(nd) trimester and blister formation are risk factors for prematurity and low birth weight. Rarely the newborn may be affected by very transitory blisters. Efficiency of very potent topical corticosteroids has been showed in several studies, and they may be used as first-intent treatment in moderate forms of PG. Systemic corticosteroids are indicated in extensive forms. In very exceptional chronic or relapsing PG, immunosuppressant agents may be necessary. CONCLUSION In the absence of consensus between moderate and severe forms of the disease, precise modalities of the steroid treatment (topical or systemic, duration and rhythm of decrease) are not well defined.
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Affiliation(s)
- S Ingen-Housz-Oro
- Service de dermatologie, hôpital Henri-Mondor, 51 avenue du Maréchal-De-Lattre-de-Tassigny, Créteil, France.
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Ingen-Housz-Oro S, Bedane C, Prost C, Joly P, Bernard P. [Pemphigoid gestationis. Guidelines for the diagnosis and treatment. Centres de référence des maladies bulleuses auto-immunes. Société Française de Dermatologie]. Ann Dermatol Venereol 2011; 138:264-6. [PMID: 21397157 DOI: 10.1016/j.annder.2011.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 01/07/2011] [Indexed: 10/18/2022]
Affiliation(s)
- S Ingen-Housz-Oro
- Service de dermatologie, hôpital Henri-Mondor, 51 avenue du Maréchal-de-Lattre-de-Tassigny, Créteil, France.
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Lu PD, Ralston J, Kamino H, Stein JA. Pemphigoid gestationis. Dermatol Online J 2010; 16:10. [PMID: 21163161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
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.
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Affiliation(s)
- Phoebe D Lu
- Department of Dermatology, New York University, New York, NY, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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Affiliation(s)
- Eric Estève
- CHR Orléans, hôpital Porte-Madeleine, service de dermatologie, rue Porte-Madeleine, 45032 Orléans cedex 1, France.
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29
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Nuara AA, Obadiah JM, Hurley MY. Pemphigoid gestationis: cutaneous manifestation of impaired fetal allograft tolerance. Skinmed 2010; 8:121-123. [PMID: 20527151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Anthony A Nuara
- Department of Dermatology, St. Louis University School of Medicine, St. Louis, MO 63104, USA
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Heazell AEP, Sinha A, Bhatti NR. A case of gestational diabetes arising following treatment with glucocorticosteroids for pemphigoid gestationis. J Matern Fetal Neonatal Med 2009; 18:353-5. [PMID: 16390798 DOI: 10.1080/14767050500275705] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
- A E P Heazell
- Department of Obstetrics and Gynaecology, City Hospital, Birmingham, UK.
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31
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Roth MM. Specific pregnancy dermatoses. Dermatol Nurs 2009; 21:70-81. [PMID: 19507373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
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.
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Affiliation(s)
- Maria-Magdalena Roth
- Department of Dermatology, Dermato-Venereology Clinic, Medical University of Timioara, Romania
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32
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van Luijt PA, Dijksterhuis MGK. [Diagnostic image. A woman in childbed with itch and vesicles]. Ned Tijdschr Geneeskd 2009; 153:B356. [PMID: 19785854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A 37-year-old woman in childbed developed gestational pemphigoid.
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Affiliation(s)
- Paula A van Luijt
- Ikazia Ziekenhuis, afd. Gynaecologie en Verloskunde, Rotterdam, The Netherlands.
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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.
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Affiliation(s)
- Marina Flangini Cobo
- Department of Dermatology, Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil
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34
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Saidi W, Joly P. [Topical or systemic corticosteroids in patients with pemphigoid gestationis and polymorphic eruption of pregnancy]. Ann Dermatol Venereol 2008; 135:865-6. [PMID: 19084701 DOI: 10.1016/j.annder.2008.05.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Accepted: 05/30/2008] [Indexed: 11/15/2022]
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Rodrigues CDS, Filipe P, Solana MDM, Soares de Almeida L, Cirne de Castro J, Gomes MM. Persistent Herpes Gestationis Treated with High-dose Intravenous Immunoglobulin. Acta Derm Venereol 2007; 87:184-6. [PMID: 17340036 DOI: 10.2340/00015555-0209] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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Affiliation(s)
- Luis A Castro
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota 55905, USA
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Villegas M, Goff HW, Kraus EW, Usatine RP. Blisters during pregnancy--just with the second husband. J Fam Pract 2006; 55:953-6. [PMID: 17090354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Maria Villegas
- University of Texas Health Sciences Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900 USA
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Dolkart L, Harter M, Snyder M. Pemphigoid gestationis: report of a case with umbilical artery Doppler assessment. J Reprod Med 2006; 51:591-4. [PMID: 16913554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
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.
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Affiliation(s)
- Lawrence Dolkart
- Department of Obstetrics and Gynecology, Arnot-Ogden Medical Center, Elmira, New York, USA.
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Affiliation(s)
- S Hanneken
- Hautklinik der Heinrich-Heine-Universität, Düsseldorf
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Faiz SA, Nainar SI, Addar MH. Herpes gestationis. Saudi Med J 2004; 25:792-4. [PMID: 15195213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
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.
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Affiliation(s)
- Shakeel A Faiz
- Department of Obstetrics and Gynecology (36), King Khalid University Hospital, PO Box 7805, Riyadh 11472, Kingdom of Saudi Arabia.
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43
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Mairos JS, Veca CP, Ribeiro R. [Herpes gestationis]. ACTA MEDICA PORT 2004; 17:107-9. [PMID: 15636736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
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.
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Affiliation(s)
- João S Mairos
- Serviço de Ginecologia/Obstetrícia, Hospital Garcia de Orta, Almada
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44
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Affiliation(s)
- Samantha Berti
- The Department of Dermatological Sciences, University of Florence, Via della Pergola 58, 50121 Florence, Italy
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Abstract
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.
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Affiliation(s)
- Lauretta Amato
- Department of Dermatology, University of Florence, Florence, Italy
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Orsini G, Loizzi P, Morelli L, Chiechi LM, Sabatini R, Distante G. [Severe form of herpes gestationis]. Minerva Ginecol 2003; 55:271-4. [PMID: 14581874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
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.
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Affiliation(s)
- G Orsini
- III U.O. di Ginecologia ed Ostetricia, Dipartimento di Scienze Chirurgiche Generali e Specialistiche, Università degli Studi di Bari, Bari, Italy.
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Nanda A, Al-Saeed K, Dvorak R, Al-Muzairai I, Al-Sabah H, Al-Arbash M, Alsaleh QA. Clinicopathological features and HLA tissue typing in pemphigoid gestationis patients in Kuwait. Clin Exp Dermatol 2003; 28:301-6. [PMID: 12780719 DOI: 10.1046/j.1365-2230.2003.01282.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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.
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Affiliation(s)
- A Nanda
- As'ad Al-Hamad Dermatology Center, Al-Sabah Hospital, Kuwait.
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Vaitkevicius V, Vaitkeviciene S, Vaitkevicius P. [Case of herpes gestationis in 5th pregnancy]. Medicina (Kaunas) 2003; 38:1217-9. [PMID: 12552164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
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.
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Agence Nationale d' Accréditation et d' Evaluation en Sante'. [Management of cutaneo-mucosal herpes in immunocompetent patients (ocular manifestations excluded)]. Presse Med 2002; 31:363-70. [PMID: 11913082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
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Affiliation(s)
- F Wojnarowska
- Department of Dermatology, Oxford Radcliffe Hospital, Oxford, England, United Kingdom
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