Pemphigoid Gestationis

Excerpt

Pemphigoid gestationis (PG), formerly herpes gestationis, is a rare, self-limiting, autoimmune subepidermal bullous dermatosis of pregnancy. PG, first described in 1872 by Laws Milton, was previously called herpes gestationis due to the herpetiform appearance of the blisters. However, the condition was not associated with the herpes virus, and the name was subsequently changed to pemphigoid gestationis. The condition typically presents during the third trimester, though it may occur during any trimester or the postpartum period, with inflammatory skin lesions and severe pruritus. The skin lesions commonly begin in the umbilical area and spread across the abdomen to the extremities; the face and mucous membranes are often spared. PG recurs in 30% to 50% of subsequent pregnancies, although typically with an earlier onset and a more severe course. Characteristic clinical features and direct immunofluorescence are typically utilized to diagnose pemphigoid gestationis; other diagnostic studies may be performed to exclude other dermatologic conditions. Treatment is comprised of supportive therapies and the prevention of new skin lesions. Corticosteroids are frequently used to treat moderate to severe cases, though intravenous immunoglobulins have also been effective in some case studies. Although PG spontaneously resolves in most patients, there is evidence that the condition is associated with preterm labor, small-for-gestational-age infants, and maternal Graves' disease. Due to the adverse effects associated with PG, clinicians should have a good comprehension of the appropriate diagnostic tests and treatments involved with pemphigoid gestationis and the ability to effectively collaborate with an interprofessional team to improve maternal and fetal outcomes.