II. Epidemiology
- Rare (1 in 60,000 pregnancies)
- Primarily in Multiparous patients in second or third trimester of pregnancy
III. Pathophysiology
- Associated with HLA-DR3, and HLA-DR4
- Autoimmune skin disorder similar to Bullous Pemphigoid
IV. Associated Conditions
- Grave's Disease
- Choriocarcinoma or Molar Pregnancy (rare)
V. Symptoms
- Intense, severe Pruritus
VI. Signs
- Onset in second or third trimester of pregnancy
- Polymorphic lesions
- Vesicles and bullae
- Distribution
- Starts on Abdomen
- Does not spare the umbilical region (unlike Polymorphic Eruption of Pregnancy)
- Spreads to thighs, palms and soles
- Starts on Abdomen
VII. Differential Diagnosis
VIII. Management
- Increased antepartum observation
- Oral Antihistamines
- Topical Corticosteroids
- Systemic Corticosteroids in severe cases
IX. Course
- Onset in second-half of pregnancy
- Improves in late pregnancy
- May be exacerbated in early Postpartum Period
- May recur in future pregnancies (or with hormonal therapy such as Oral Contraceptives)
X. Complications
- Preterm delivery
- Small for Gestational Age infant
- Newborns dermatitis (10% of cases)