Pemphigoid Gestationis: Autoimmune Rash During Pregnancy

Pemphigoid or Herpes Gestationis Symptoms and Diagnosis

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

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

This condition 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 at 21 weeks gestation.

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

  1. 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, and inside of the mouth.
  3. After 2 to 4 weeks of this rash, large, tense blisters form at the edges of the rash or in apparently normal skin. These blisters heal without scarring if they do not get infected.
  4. 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% of women.

The rash may also recur when menses resumes or with the use of oral contraceptives. With subsequent pregnancies, pemphigoid gestationis usually recurs earlier and may be more severe. Only 8% of women do not develop pemphigoid gestationis in subsequent pregnancies.

Cause & Diagnosis

The cause of pemphigoid gestationis is autoimmune (a disordered immune condition where antibodies attack the body's own healthy tissues).

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.

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.

Effect on Baby

Because antibodies cross the placenta, the antibodies that cause pemphigoid gestationis can affect the baby as well. A noticeable rash has been reported in 5% of newborns born to moms with this condition.

This newborn rash lasts only for a short time (about 3-4 months) and resolves on its own without treatment. Infected blisters may leave scars.

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.


Castro LA, Lundell RB, Krause PK, Gibson LE (November 2006). "Clinical experience in pemphigoid gestationis: report of 10 cases". J. Am. Acad. Dermatol.55 (5): 823–8.

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