Herpes gestationis persisting for 12 years post partum

Holmes, R. C.

doi:10.1001/archderm.122.4.375b

Cited by 13 publications

(7 citation statements)

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“…One patient received azathioprine due to the chronic course of her disease, and the lesions lasted for over one year. Prolonged courses of PG,11–14 as well as transformation of the disease into BP 15 have been described. Many attempts to differentiate chronic PG from BP have been made: PG is associated with HLA DR3 and DR4, while BP is associated with HLA-DQ3 2,16,17.…”

Section: Discussionmentioning

confidence: 99%

Pemphigoid Gestationis: Clinical and Laboratory Evaluation

Cobo

Santi

Maruta

et al. 2009

Clinics

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INTRODUCTIONPemphigoid gestationis, also known as herpes gestationis, is a rare autoimmune blistering disease associated with pregnancy. It usually occurs during the second or third trimester, but it may be present at any stage of pregnancy or the puerperium. The clinical, histologic, and immunopathological features of pemphigoid gestationis are similar to those of the pemphigoid group of disorders.METHODSWe hereby report seven patients who were diagnosed with pemphigoid gestationis and followed at the Autoimmune Blistering Disease Clinic in the Department of Dermatology of the University of Sao Paulo Medical School between 1996 and 2008.DISCUSSIONDemographic and clinical findings, such as median age, sites of involvement, and gestational age of onset or C3 of our patients, coincide with those described in previous reports. The majority of patients (85%) exhibited complement C3 and immunoglobulin G (IgG) deposition along the basement membrane zone (BMZ) on immunofluorescence. Herpes gestationis factor (HG) factor was postitive in four out of six patients (67%), and three out of five patients recognized the bullous pemphigoid recombinant antigen (BP180) by ELISA.CONCLUSIONThis study revealed a good outcome of the newborns from pemphigoid gestationis affected mothers, based on the absence of pemphigoid gestationis cutaneous lesions, mean birth weight, and normal Apgar scores and gestational age at birth.

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Section: Discussionmentioning

confidence: 99%

Pemphigoid Gestationis: Clinical and Laboratory Evaluation

Cobo

Santi

Maruta

et al. 2009

Clinics

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“…The lesions usually occur on the abdomen (especially umbilical region), forearm, thigh, trunk, mammary region, and buttocks. The face, scalp, neck, and mucous membrane are only occasionally involved 3–8 . Cases in which active disease persists for months to many years after delivery are designated by the term “persistent HG.” Currently four cases have been reported in literature 6,7,9–11 .…”

Section: Commentmentioning

confidence: 99%

“…Currently, four cases have been reported in the literature 6,7,9–11 . Holmes et al, in 1983 6 and again in 1986, 7 reported the first case, concerning a 25‐year‐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 28‐year‐old woman who had active HG for over 13 years.…”

Section: Commentmentioning

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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“…Une poussée de la maladie peut être observée dans les jours suivant l'accouchement, liée à une subite augmentation du taux des anticorps, détectable en méthode Elisa, juste avant et juste après l'accouchement [9]. La guérison survient en général en quelques semaines à quelques mois après l'accouchement, mais des évolutions très prolongées sont possibles, jusqu'à 12ans [10]. Le taux de rechute lors des grossesses ultérieures est important [11].…”

Section: Introduction:-unclassified