Elsevier

Clinics in Dermatology

Volume 24, Issue 2, March–April 2006, Pages 109-112
Clinics in Dermatology

Herpes gestationis (Pemphigoid gestationis)

https://doi.org/10.1016/j.clindermatol.2005.10.011Get rights and content

Abstract

Herpes gestationis, coined by Milton in 1872, or gestational pemphigoid is the most clearly characterized dermatosis of pregnancy. It is a rare vesiculo-bullous eruption that develops during the last trimester or even postpartum and creates severe pruritus. Its etiology is unknown, but it is considered as an autoimmune-mediated dermatosis closely related to the pemphigoid group. Herpes gestationis is associated with a positive C3 deposition along the base of the epidermis in salt–split skin, with increased frequency of HLA-DR3 and also the combination DR3 and DR4. It has a high risk of prematurity and disappears in the postpartum period within weeks or months.

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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