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Herpes (pemphigoid) gestationis
Etiology:
- non-viral vesiculobullous dermatitis of pregnancy
Epidemiology: rare
Pathology:
1) subepidermal bulla with eosinophils
2) deposition of C3 in a linear pattern along the basement membrane
3) deposition of IgG along with C3 in 30-40% of cases
4) circulating antibody crosses placenta
5) baby born to mother may develop transient vesiculobullous dermatitis during the neonatal period
Clinical manifestations:
1) intensely pruritic urticarial papules, plaques or blisters
2) generally occurs in last 1/2 of pregnancy
Laboratory:
1) biopsy: direct immunofluorescence
2) serum contains 'HG factor' in 50% of patients
3) labs with Loincs
- Herpes gestationis Ab in serum
- Herpes gestationis IgG complement fixing in serum
- Herpes gestationis IgG non complement fixing in serum
4) see ARUP consult [3]
Management:
1) topical glucocorticoids
2) prednisone 20-40 mg PO QD
-> newborns at risk of reversible adrenal insufficiency
Related
Herpes gestationis (HG) factor
General
vesiculobullous dermatitis
dermatoses of pregnancy
References
- Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed)
Lippincott-Raven, Philadelphia, 1998, pg 167-68
- Harrison's Principles of Internal Medicine, 13th ed.
Isselbacher et al (eds), McGraw-Hill Inc. NY,
1994, pg 287
- ARUP Consult: Pemphigoid Gestationis - Herpes Gestationis
The Physician's Guide to Laboratory Test Selection & Interpretation
https://www.arupconsult.com/content/pemphigoid-gestationis