Pemphigoid Gestationis

Diagnosis: Pemphigoid Gestationis

Tense vesicles with crusted erosions (ruptured bullae) on the periumbilical area.

Clinical Presentation

Tense vesicles with crusted erosions (ruptured bullae) on the periumbilical area.

Clinical History

Submitted by Alaa Saad. Originally posted October 24, 2010.

Treatment

See case discussion.

Differential Diagnosis

• PUPPP (pruritic urticarial papules and plaques of pregnancy) • Atopic eruption of pregnancy • Drug eruption • Urticaria • Bullous pemphigoid • Dermatitis herpetiformis

Key Learnings

• Autoimmune blistering disease of pregnancy — IgG against BP180 (same target as BP) • Formerly called herpes gestationis (misnomer — no viral association) • Usually starts periumbilically in 2nd-3rd trimester • DIF: linear C3 (100%) ± IgG at DEJ — C3 deposition is the hallmark • Risk of neonatal pemphigoid gestationis (~5-10% of neonates) — transient, self-limited • Flares postpartum, with menses, and with OCPs • Increased risk of prematurity and SGA neonates • Recurs in subsequent pregnancies, often earlier and more severely

Tags: pemphigoid, gestationis, alaa saad