Herpes Gestationis
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 (Pemphigoid Gestationis)
- Herpes Gestationis, also called Pemphigoid Gestationis, is a rare autoimmune blistering disorder of pregnancy. ❌ Despite the name, it is not caused by the herpes virus.
- The term originated because of vesicles resembling herpes, but histology reveals an autoimmune bullous dermatosis.
- Incidence: ~1 in 50,000 pregnancies, most often in the 2nd or 3rd trimester.
- Characterized by intensely pruritic, bullous eruptions with erythematous bases.
🧾 Clinical Features
- Initial severe itching → papular rash → vesicles and tense bullae.
- Classically begins periumbilically, then spreads to trunk and limbs.
- Pathophysiology: maternal autoantibodies attack hemidesmosomal proteins (BP180, BP230), causing subepidermal blistering.
- DIF: Linear C3 (± IgG) at the basement membrane zone.
- Rare neonatal involvement: transient blisters due to transplacental maternal IgG.
- Resolves postpartum, but recurs in later pregnancies.
🔬 Investigations
- Skin Biopsy: Edge of active blister → shows subepidermal blistering with eosinophil/neutrophil infiltrate.
- Direct Immunofluorescence (DIF): Linear C3 (± IgG) at BMZ = diagnostic.
- Indirect Immunofluorescence: Detects circulating autoantibodies to BP180/BP230.
- ELISA: Confirms and quantifies BP180/BP230 autoantibodies.
- CBC: Often normal; mild eosinophilia possible.
- Amniocentesis: Rarely required, but may assess severe cases with suspected fetal compromise.
💊 Management
- Mild: Symptomatic care → emollients, cool baths, and topical corticosteroids for itching and inflammation.
- Severe: Systemic corticosteroids (e.g. prednisolone) are first-line. Dose adjusted to disease severity and maternal–fetal safety.
- Monitoring: Regular maternal + fetal review (growth scans, obstetric input) due to small risk of preterm delivery and low birth weight.
- Postpartum: Typically resolves after birth, but relapses are common in subsequent pregnancies or with OCP use.
