Related Subjects:
|Nikolsky's sign
|Koebner phenomenon
|Erythema Multiforme
|Pyoderma gangrenosum
|Erythema Nodosum
|Dermatitis Herpetiformis
|Lichen Planus
|Acanthosis Nigricans
|Acne Rosacea
|Acne Vulgaris
|Alopecia
|Vitiligo
|Urticaria
|Basal Cell Carcinoma
|Malignant Melanoma
|Squamous Cell Carcinoma
|Mycosis Fungoides (Sezary Syndrome)
|Xeroderma pigmentosum
|Bullous Pemphigoid
|Pemphigus Vulgaris
|Seborrheic Dermatitis
|Pityriasis/Tinea versicolor infections
|Pityriasis rosea
|Scabies
|Dermatomyositis
|Toxic Epidermal Necrolysis
|Stevens-Johnson Syndrome
|Atopic Eczema/Atopic Dermatitis
|Psoriasis
About
- Herpes Gestationis, also known as *Pemphigoid Gestationis*, is not related to herpes virus infections despite its name.
- The condition was historically misnamed because of histological similarities, such as the presence of vesicles and blisters, which resemble herpes lesions.
- It is a rare autoimmune bullous disorder, typically occurring in late pregnancy, affecting about 1 in 50,000 pregnancies.
Clinical Features
- Begins with mild to severe pruritus (itching) and may progress to a papular rash, followed by vesicles and blisters.
- The rash commonly starts around the periumbilical (around the navel) area but can spread to other parts of the body.
- Autoantibodies target hemidesmosome proteins, leading to a subepidermal blistering process.
- Direct immunofluorescence shows linear deposition of complement component C3 along the basement membrane zone.
- In some cases, the newborn may develop transient blisters due to the transplacental transfer of maternal IgG antibodies.
- The condition typically resolves after delivery without scarring, although recurrence is common in subsequent pregnancies.
Investigations
- Skin Biopsy: A biopsy taken from the edge of an active blister or rash can help confirm the diagnosis. Histopathology will show subepidermal blistering.
- Direct Immunofluorescence (DIF): A skin biopsy examined by immunofluorescence will reveal a linear deposition of C3 (and sometimes IgG) along the basement membrane zone.
- Indirect Immunofluorescence: Blood samples may be tested for circulating antibodies (anti-BP180 and anti-BP230) directed against hemidesmosome proteins.
- Serology: Enzyme-linked immunosorbent assay (ELISA) may be used to detect specific antibodies (BP180 and BP230) in the blood.
- Complete Blood Count (CBC): A CBC may be performed to rule out other underlying conditions or complications, though it is often normal in these patients.
- Amniocentesis (in rare cases): If severe fetal involvement is suspected, amniocentesis may be performed to assess fetal health and the potential impact of the disease on the pregnancy.
Management
- For mild cases, treatment includes tepid baths, emollients, and topical corticosteroids to reduce inflammation and relieve itching.
- In severe cases with widespread blistering, systemic corticosteroids (e.g., prednisone) may be necessary to control the disease.