Herpes gestationis (Pemphigoid gestationis)
Introduction
Herpes gestationis (HG), which has been called pemphigoid gestationis or gestational pemphigoid, was first identified in 1872 by John Laws Milton, the founder of London's St John's Hospital for Diseases of the Skin. It is characterized by pruritic and/or urticarial plaques containing vesicles beginning on the abdomen and can extend to become a generalized bullous eruption. Both the clinical pictures and the laboratory findings resemble those of bullous pemphigoid (BP).
Section snippets
Pathology and immunology
Immunofluorescence (IF) techniques, first done in 1973, reveal complement deposition along the basement membrane zone (BMZ), a feature that is considered now to be important in making the diagnosis of HG.1 The histopathologic and IF findings are similar to those of BP. The pathology usually demonstrates subepidermal vesicles, a spongiotic epidermis, and some perivascular lymphocyte and histiocyte infiltrates with a preponderance of eosinophils (Fig. 1, Fig. 2).
Electron microscopic studies have
Treatment
The first line in the treatment of HG especially in advanced lesions is systemic corticosteroids with a dose of 0.5 mg/kg of prednisolone daily.18 The daily dose should not exceed 80 mg, except in rare occasions, when the condition is severe, where 180 mg daily has been used.19 Some authors suggest increasing the steroid for a short time in the early postpartum period to prevent postpartum exacerbations.20
Early urticarial lesions may respond to topical corticosteroids,21 in addition to oral
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Cited by (41)
Retrospective analysis of pemphigoid gestationis in 32 Saudi patients - Clinicopathological features and a literature review
2016, Journal of Reproductive ImmunologyCitation Excerpt :The disease may progress and may be exacerbated postpartum, especially if it goes untreated or uncontrolled. Recurrences have been reported to occur during subsequent pregnancies, during menstruation, and with oral contraceptive use (Jenkins et al., 1999; Al-Fouzan et al., 2006; Engineer et al., 2000). Recently, immunoblotting (IB) and enzyme-linked immunosorbent assays (ELISAs) of the NC16a domain of BP180 have been shown to be sensitive diagnostic tools in PG (Tani et al., 2015).
Diagnostic Pathology: Nonneoplastic Dermatopathology
2016, Diagnostic Pathology: Nonneoplastic DermatopathologyAutoimmune blistering diseases in females: A review
2015, International Journal of Women's DermatologyCitation Excerpt :Since then, there have been several medium-sized case series on PG, although large epidemiology studies have been limited. Pemphigoid gestationis has an incidence of 1 case in 50,000 to 60,000 pregnancies (Al-Fouzan et al., 2006; Cobo et al., 2009). A recent review found it may be the second-most-common AIBD overall after BP, accounting for 9.75% of 41 AIBD cases in one study (Bertram et al., 2009).
JAAD Grand Rounds quiz<sup>∗</sup>: Adult with vesicles and bullae
2014, Journal of the American Academy of DermatologyRecurrent pemphigoid gestationis in the puerperium
2013, Clinica e Investigacion en Ginecologia y ObstetriciaPemphigoid gestationis
2012, Clinics in DermatologyCitation Excerpt :Pemphigoid gestationis (PG) is intensely pruritic and a rare autoimmune vesiculobullous dermatosis of pregnancy closely related to the pemphigoid group of blistering disorders, with an incidence of 1:50,000 to 60,000 pregnancies.1-7