Pemphigoid Gestationis

Aka: Pemphigoid Gestationis, Herpes Gestationis

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II. Epidemiology

  1. Rare (1 in 60,000 pregnancies)
  2. Primarily in Multiparous patients in second or third trimester of pregnancy

III. Pathophysiology

  1. Associated with HLA-DR3, and HLA-DR4
  2. Autoimmune skin disorder similar to Bullous Pemphigoid
    1. Reaction to hemidesmosomal Proteins within the Dermis and Epidermis

IV. Associated Conditions

  1. Grave's Disease
  2. Choriocarcinoma or Molar Pregnancy (rare)

V. Symptoms

  1. Intense, severe Pruritus

VI. Signs

  1. Onset in second or third trimester of pregnancy
  2. Polymorphic lesions
    1. Vesicles and bullae
  3. Distribution
    1. Starts on Abdomen
      1. Does not spare the umbilical region (unlike Polymorphic Eruption of Pregnancy)
    2. Spreads to thighs, palms and soles

VII. Differential Diagnosis

  1. See Pruritus in Pregnancy
  2. See Pruritus Causes
  3. Pruritic Urticarial Papules and Plaques of Pregnancy (Polymorphic Eruption of Pregnancy)

VIII. Management

  1. Increased antepartum observation
  2. Oral Antihistamines
  3. Topical Corticosteroids
  4. Systemic Corticosteroids in severe cases

IX. Course

  1. Onset in second-half of pregnancy
  2. Improves in late pregnancy
  3. May be exacerbated in early Postpartum Period
  4. May recur in future pregnancies (or with hormonal therapy such as Oral Contraceptives)

X. Complications

  1. Preterm delivery
  2. Small for Gestational Age infant
  3. Newborns dermatitis (10% of cases)
    1. Vesicles and bullae may be transiently seen in newborns due to passive Antibody transfer

XI. References

  1. Erlandson (2023) Am Fam Physician 107(2): 152-8 [PubMed]

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Related Studies

Ontology: Pemphigoid Gestationis (C0019343)

Definition (NCI) An autoimmune bullous dermatitis that develops during pregnancy, most often during the second and third trimesters.(NICHD)
Definition (MSH) An itching, autoimmune, bullous SKIN disease that occurs during the last two trimesters of PREGNANCY and PUERPERIUM. It also affects non-pregnant females with tissue of PLACENTA origin, such as CHORIOCARCINOMA; or HYDATIDIFORM MOLE. It exhibits antigenic and clinical similarity to bullous pemphigoid (PEMPHIGOID, BULLOUS). This disease does not involve herpes viruses (old name, herpes gestationis).
Concepts Pathologic Function (T046)
MSH D006559
ICD10 O26.4 , O26.40
SnomedCT 199131000, 270959002, 199126002, 156129002, 86081009
LNC LP36878-4
English Herpes gestationis NOS, Herpes gestationis unspecified, herpes gestationis, herpes gestationis (diagnosis), Pemphigoid, Gestational, Pemphigoids, Gestational, Gestational Pemphigoid, Gestational Pemphigoids, Herpes gestationis, unspecified trimester, Pemphigoid Gestationis [Disease/Finding], pemphigoid gestationis, Herpes gestationnis, Gestational herpes, Herpes gestationis unspecified (disorder), Herpes gestationis NOS (disorder), Herpes gestationis, Dermatitis herpetiformis of pregnancy, Pemphigoid gestationis, Herpes gestationis (disorder), gestational; herpes, herpes; gestational, Herpes Gestationis, Gestationi, Pemphigoid, Pemphigoid Gestationi, Pemphigoid Gestationis, Gestationis, Pemphigoid
Italian Herpes gestazionis, Pemfigoide della gravidanza, Herpes gestazionale
Dutch pemfigoïd gestationis, gestationis; herpes, herpes; gestationis, herpes gestationis, Herpes gestationis
French Pemphigoïde gestationnelle, Herpès gestationis, Pemphigoïde gestationis, Herpes gestationis, Pemphigoïde gravidique
German Pemphigoid gestationis, Herpes gestationnis, Herpes gestationis
Portuguese Penfigóide gestacional, Penfigoide Gestacional, Herpes gestationis
Spanish Penfigoide gestacional, Herpes gestacional, herpes gestacional, SAI (trastorno), herpes gestacional, no especificado (trastorno), herpes gestacional, no especificado, herpes gestacional, SAI, dermatitis herpetiforme del embarazo (trastorno), dermatitis herpetiforme del embarazo, herpes gestacional (trastorno), herpes gestacional, Herpes del embarazo, Penfigoide Gestacional
Japanese 妊娠性類天疱瘡, ﾆﾝｼﾝｾｲﾙｲﾃﾝﾎﾟｳｿｳ, ﾆﾝｼﾝﾍﾙﾍﾟｽ, 妊娠性疱疹, 妊娠性ヘルペス, 疱疹-妊娠性, ヘルペス-妊娠性, 妊娠ヘルペス, 妊娠疱疹
Swedish Pemphigoid gestationis
Czech pemphigoid gestationis, pemfigoid gestační, herpes gestationis, Gestační pemfigoid, Herpes v těhotenství, Herpes gestationis
Finnish Raskausrokahtuma
Russian PEMFIGOID BEREMENNYKH, GERPES BEREMENNYKH, ГЕРПЕС БЕРЕМЕННЫХ, ПЕМФИГОИД БЕРЕМЕННЫХ
Korean 임신 헤르페스
Polish Opryszczki ciężarnych
Hungarian Herpes gestationis, terhességi herpes, Pemphigoid, gestatios
Norwegian Herpes gestationis, Pemphigoid gestationis, Svangerskapspemfigoid
Derived from the NIH UMLS (Unified Medical Language System)

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