Pemphigoid Gestationis Is An Autoimmune Rash During Pregnancy

Pemphigoid or Herpes Gestationis Effect on Mother and Baby

Pemphigoid gestationis occurs during the second and third trimesters.
Pemphigoid gestationis occurs during the second and third trimesters. Westend61/Getty Images

There are a number of different rashes women may experience during pregnancy. Of these, pemphigoid gestionis or herpes gestationis is fairly uncommon.

What is Pemphigoid Gestionis?

Pemphigoid gestationis is also known as herpes gestationis, although the latter name is misleading since this condition is not associated with the herpes virus, nor any other virus. This is a rare, itchy, autoimmune disease that occurs during the second and third trimesters of pregnancy and around the time of delivery.

Pemphigoid gestationis occurs in 1 per 7,000 to 50,000 pregnancies.

What Pemphigoid Gestationis Looks Like

Pemphigoid Gestationis usually starts during the second or third trimester, although it has been reported in the first trimester and a short time after delivery. The average appearance is mid-pregnancy, at 21 weeks gestation.

Pemphigoid gestationis appears in the following stages, with distinct symptoms:

  1. The condition begins with very itchy, red hives or small bumps around the belly button.
  2. Within days to weeks, the rash spreads, and the hives and bumps join to form bizarrely shaped circular patches that cover a wide area of skin. The rash can involve:
    • The torso
    • Back
    • Buttocks
    • Forearms
    • Palms of hands
    • Soles of the feet
    • It usually does not involve the face, scalp, or the inside of the mouth
  3. After two to four weeks of this rash, large, tense blisters form at the edges of the rash or in the apparently normal skin. These blisters heal without scarring if they do not get infected.
  1. Some women may not have any blisters, instead, they may have large raised patches called plaques.

Spontaneous clearing of the rash may occur later in the pregnancy, but uncomfortable flares occur immediately prior to delivery in 75 to 80 percent of women.

The rash may also recur when menses resumes or with the use of oral contraceptives.

With subsequent pregnancies, pemphigoid gestationis usually begins earlier in the pregnancy than it did before and may be more severe. Only eight percent of women do not have a recurrence pemphigoid gestationis in subsequent pregnancies.

What Causes Pemphigoid Gestationis?

It's not certain exactly what causes pemphigoid gestationis, but it is considered a type of autoimmune disease. Autoimmune diseases are conditions in which the body forms antibodies which attack its own tissues (self against self.) Antibodies attach to certain types of connective tissue in the skin and cause an inflammatory response. This response is manifested by redness, itching, swelling, and blister formation.

Diagnosis

Pemphigoid gestationis is usually diagnosed by taking skin biopsies of different areas of the rash and normal-appearing skin. A special test to detect antibodies called direct immunofluorescence is performed on the biopsies to make the diagnosis.

Differential Diagnosis - What Else Could it Be?

There are a number of conditions which may cause rashes and itching during pregnancy. In addition to the tests noted above, the rash may be distinguished by its location and appearance as well as the absence of findings seen with some of these other conditions.

Effect on Baby

Because antibodies cross the placenta, the antibodies that cause pemphigoid gestationis may affect the baby as well. A noticeable rash has been reported in five percent of newborns born to moms with this condition.

This newborn rash lasts only for a short time (about three to four months) and resolves on its own without treatment. Infected blisters may leave scars, so it is important to keep the area clean in an infant and call her pediatrician with any worsening, such as redness or drainage.

There is evidence that women with pemphigoid gestationis have an increased risk of premature delivery.

Current studies indicate that there is not an increased risk of miscarriage or stillbirth.

Treatment Options for Pemphigoid Gestationis

A few women with very mild cases of pemphigoid gestationis can be treated with steroid creams and antihistamines. However, the majority of women require oral steroids to control their symptoms. A high dose is usually used to get symptoms under control and then tapered as the rash improves.

Bottom Line on Pemphigoid Gestationis

While pemphigoid gestationis can be uncomfortable for a pregnant woman and can recur with subsequent pregnancies, the fact that it is not associated with miscarriage or stillbirth may be of some consolation for those coping with the severe itching and rash. Since women are often more concerned about the baby, it is also reassuring that only a small percent of infants experience the rash, and the condition does not otherwise interfere with the health of a newborn (with the exception of premature delivery if this is related.) We are still uncertain about the role of pemphigoid gestationis in contributing to premature deliveries, and it is wise for women coping with the condition to talk to their obstetrician about anything they can do to lower the risk, and signs and symptoms of preterm labor which should prompt them to call right away.

Sources:

Savervall, C., Sand, F., and S. Thomsen. Dermatological Diseases Associated with Pregnancy: Pemphigoid Gestationis, Polymorphic Eruption of Pregnancy, Intrahepatic Cholestasis of Pregnancy, and Atopic Eruption of Pregnancy. Dermatology Research and Practice. 2015. 1025:979635.

Seidel, R., Lavi, N., and L. Chipps. Pemphigoid Gestationis: A Case Report and Review of Management. Journal of Drugs in Dermatology. 2015. 14(8):904-7.

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