Herpes gestationis. Persistent disease activity 11 years post partum

Fine, J. D.

doi:10.1001/archderm.121.7.924

Cited by 16 publications

(12 citation statements)

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“…Evolution is cyclical with lesions disappear within weeks or months after delivery and recurrence in subsequent pregnancies, or sometimes minima during menstruation, during ovulation or during the combined hormonal outlet [21]. Exacerbation in immediate postpartum period is noted in 50 to 75 percent.…”

Section: Discussionmentioning

confidence: 99%

Pemphigoid gestationis: A Moroccan study

Chakiri¹,

Salim²,

Inani³

et al. 2017

Our Dermatol Online

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Section: Discussionmentioning

confidence: 99%

Pemphigoid gestationis: A Moroccan study

Chakiri¹,

Salim²,

Inani³

et al. 2017

Our Dermatol Online

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“…5 However, these agents are contraindicated during pregnancy. Gold and methotrexate 6 have been used previously but their efficacy was uncertain. Dapsone has been used in various reports 6,7 but sulphones had been reported to be ineffective in a case series of 11 patients.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of a severe persistent case of pemphigoid gestationis with antepartum and postpartum intravenous immunoglobulin followed by azathioprine

2012

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We report a case of pemphigoid gestationis affecting a 37-year-old woman in both her pregnancies. In her second pregnancy she failed to respond to high-dose oral prednisolone. She was treated successfully with intravenous immunoglobulin (2 g/kg each infusion cycle) as a steroid-sparing agent during both the antepartum and postpartum period. The baby was born at the 36th week of gestation. No complications were noted for either mother or baby. After ceasing intravenous immunoglobulin, azathioprine (up to a dose of 1 mg/kg/day) was used to adequately control her pemphigoid gestationis.

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“…Currently four cases have been reported in literature. 6,7,[9][10][11] The patient described above presented with HG appearing in the seventh month of her second pregnancy and thereafter persisting for 11 consecutive months. Immunopathologic findings, as well as HLA typing are also indicative of persistent HG.…”

Section: Commentmentioning

confidence: 98%

“…Currently, four cases have been reported in the literature. 6,7,[9][10][11] Holmes et al, in 1983 6 and again in 1986, 7 reported the first case, concerning a 25year-old patient, affected during her first late pregnancy by HG and unsuccessfully treated with high doses of systemic corticosteroids and subsequently with azathioprine, that did not control the disease which was active for 12 years. Then Fine and Omura 9 reported on a 28year-old woman who had active HG for over 13 years.…”

Section: Numerous Erythematous-edematous Figured Lesions With Groupementioning

confidence: 99%

Persistent Herpes Gestationis

Berti

Amato

Coronella

et al. 2002

Skinmed

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A 36-year-old woman at the 31st gestation week of her second pregnancy presented with erythematous-edematous lesions associated with little blisters localized on the periumbilical area that spread to the abdomen, mammary area and folds (Figures 1A and 1B). Histologic and immunopathologic exams were performed. She had not developed any cutaneous lesions in her first pregnancy or in association with menstruation or oral contraceptives. The patient was treated with local corticosteroids with a modest and temporary improvement. She delivered a healthy boy with a normal birth weight and a normal Apgar score. Small bullous lesions continued to appear in the postpartum period and during the feeding (for 9 months postpartum), which were associated with mild pruritus and partially controlled by topical corticosteroids. ResultsA lesional skin biopsy specimen routinely processed and stained with hematoxylin and eosin demonstrated a subepidermal vesiculo-bullous dermatosis and a perivascular and interstitial infiltrate of lymphocytes and eosinophils, localized in deep and superficial dermis. Direct immunofluorescence (IF) of perilesional skin performed on 6 µm cryostat-cut sections using a standard technique with fluorescein labeled antihuman immunoglobulin (Ig)G, IgA, IgM and C3, showed linear IgG (+) and C3 (+++) deposit at the basement membrane zone (BMZ). Using direct salt-split skin technique, IgG antibodies on the epidermal side of the separated skin were demonstrated (Figure 2). Indirect IF on a monkey esophagus substrate, demonstrated circulating IgG1 autoantibodies against BMZ antigens, at titer 1:80, and an indirect complement fixation test using the patient's serum, on human saltsplit skin, showed C3 deposits along the BMZ on the epidermal side (titer 1:160). Immunoblot analysis on patient serum revealed that circulating autoantibodies were directed against a 180-kd antigen (BPAg2).Routine blood examinations revealed lymphopenia (18.8%) and fibrinogen (565 mg/dL), alkaline phosphatase (450 U/L), cholesterol (308 mg/dL), and triglyceride (320 mg/dL) increases. Antithyroid autoantibodies, antigastric mucosa autoantibodies, and antinuclear autoantibodies were negative. HLA typing demonstrated an A3, A25, B18, B38, Cw7, DR4, DRw53, DQ5, and DQ8 phenotype.At 9 months postpartum, the patient stopped breast-feeding and was treated for the persisting cutaneous manifestations, with doxycycline (200 mg/daily) and nicotinamide (500 mg/ daily). This pharmacologic treatment was progressively reduced (doxycycline 100 mg/daily and nicotinamide 250 mg/daily) and we obtained a complete remission in 2 months of therapy. After 6 months from therapy suspension, no new cutaneous lesion appeared. CommentHerpes gestationis (HG), also known as pemphigoid gestationis, is a rare dermal-epidermal bullous, autoimmune disease of pregnancy and puerperium. The first onset of HG is usually in the second or third trimester of pregnancy, but it can develop from 2 months before, until 5-6 days after delivery. HG usually clears up in the last weeks...

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Herpes gestationis. Persistent disease activity 11 years post partum

Cited by 16 publications

References 0 publications

Pemphigoid gestationis: A Moroccan study

Pemphigoid gestationis: A Moroccan study

Successful treatment of a severe persistent case of pemphigoid gestationis with antepartum and postpartum intravenous immunoglobulin followed by azathioprine

Persistent Herpes Gestationis

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