Herpes Gestationis

Abstract

HG expresses a broader clinical range than previously thought. Disease may be mild and nonvesicular during one pregnancy, followed by explosive vesiculobullous disease during another. On the other hand, patients with extensive HG during one pregnancy may experience mild or even subclinical disease during a subsequent gestation. The broad range of clinical signs and the lack of demonstrable fetal or maternal risk associated with HG have important ramifications for patients desirous of further children. There is a genetic predisposition to HG. DRB1*0301 (HLA-DR3) is increased and 90% of patients express either DRB1*0301 (HLA-DR3) or DRB1*0401/040X (HLA-DR4). Ninety percent of patients also carry a C4 null allele, which may be due to linkage dysequilibrium with DRB1*0301 or DRB1*0401/040X. The disease appears to be mediated by an IgG1 specific for a 180-kD component of hemidesmosomes. This protein is distinct from the 240-kD hemidesmosomal antigen seen in BP and is coded for by a different cDNA on a different chromosome. Abnormal expression of class II MHC occurs in the placental villi of those with HG, suggesting ongoing immunologic stimulation. This has led some investigators to believe that the primary immunologic event is taking place within the placenta and that the skin is an immunologic bystander.

Pemphigoid gestationis: new insights into the pathogenesis lead to novel diagnostic tools

“…In rare cases, PG may be associated with hydatiform mole and choriocarcinoma 8,9 . Intense pruritus is a characteristic feature and may precede the skin lesions by days and weeks 1 . The clinical presentation of PG is polymorphic.…”

“…The disease tends to improve spontaneously during the later stages of pregnancy and exacerbate immediately after delivery 1 . Subsequent flareups may occur with menstruation or with the use of oestrogen-and/or progesteronebased oral contraceptives 5,6,13 .…”

“…Subsequent flareups may occur with menstruation or with the use of oestrogen-and/or progesteronebased oral contraceptives 5,6,13 . Skin lesions usually clear within three months after delivery without scarring or milia formation 1 . Nursing may affect the duration of the disease postpartum.…”

“…It is not related to herpes virus infection; the old term rather reflects the occurence of herpetiform lesions as a part of the clinical picture 1 . Table 1 summarises the major autoimmune blistering diseases subdivided into those with intra-and subepidermal split formation.…”

Pemphigoid gestationis: A Moroccan study

“…Exacerbation in immediate postpartum period is noted in 50 to 75 percent. 100 cases in the literature [22,23] and occurs in 12 to 48 first hours after birth. It was not found in our series.…”