Table Of Contents
Gestational Pemphigoid (Pemphigoid gestationis)
This refers to a bullous pemphigoid-like dermatosis that occurs in pregnancy, usually during the 2nd and 3rd trimesters.
Aetiology is unknown, but most likely immunological. BP180 protein, which is identified in bullous pemphigoid, is also found in the placenta, possibly explaining disease onset in pregnancy.
- Features
- Commonly begins in the periumbilical region, progresses to involve extremities. Mucus membranes may be affected, though not commonly.
- Lesions are intensely pruritic, and may be non-blistering (urticaria, or papular)
- Grouped vesicles with herpetiformis appearance may occur as disease advances (‘Gestational herpes’)
- Usually self-limiting and heals after delivery spontaneously
- Possible complications: premature labour, increased lifetime risk of developing autoimmune disease, infant may develop transient blistering after birth (resolves spontaneously)
- Diagnosis confirmed by skin biopsy and Immunofluorescence.
- Treatment should be carried out with care, reducing risk of side effects to both mother and fetus, e.g. use of minimum effective doses of steroids, avoidance of some immunosuppressive treatments until postpartum period
- Recurrence occurs, especially:
- Spontaneously during postpartum period
- When using some hormonal contraceptives
- During menstruation
- In subsequent pregnancies
- Differential diagnosis
- Pustular psoriasis of pregnancy
- Polymorphic eruption of pregnancy
- Bullous pemphiogid
- Epidermolysis bullosa acquisita
