Gestational pemphigoid

The pemphigoides gestationis is a rare autoimmune blistering skin disease which occurs in pregnancy, usually in the second or third trimester. It is also known as herpes gestationis because of similar skin findings but Herpes viruses are not involved in the disease. The disease is so rare that the largest study of the treatment includes only 87 patients.

Clinical picture

The pemphigoides gestationis usually begins around with a blistering around the navel, before it spreads to the rest of the skin. Occasionally, even painful over -heated urticaria. The local release of histamine is a strong itching.

Causes

The causes of the disease are largely unknown, an autoimmune involvement with deposition of C3 and immunoglobulin G at the dermal- epidermal junction zone is secured.

Differential diagnoses

The diagnosis is confirmed by direct immunofluorescence of skin biopsies and serological detection of antibodies. The disease can be confused with the more common PUPPP otherwise easily, especially if it occurs during the first pregnancy. However, the PUPPP usually begins in the areas of stretch marks and heal after birth within 2 weeks.

Treatment

The immunosuppressive treatment is usually with corticosteroids. During treatment the number of autoantibodies and decreases the formation of bubbles is reduced. However, the therapy is difficult and often takes several months. A definite cure of the disease is not present, however, the occurrence of a remission. Therefore, the psychological burden of this disease should be included in the treatment. Ill pregnant women should be examined for other complications of pregnancy, particularly a lack of amniotic fluid is to be excluded.