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Skin - nontumor
Blistering disorders - Pemphigoid gestationis
Author: Nat Pernick, M.D, PathologyOutlines.com, Inc.
Revised: 31 October 2009
Last major update: October 2009
Copyright: (c) 2002-2009, PathologyOutlines.com, Inc.
Definition
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● Rare, self-limiting, autoimmune, subepidermal bullous disease, occurring during or soon after pregnancy or in women taking oral contraceptives
Terminology
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● Formerly called herpes gestationis due to herpetiform nature of blisters, but disease is NOT related to herpes infection
Epidemiology
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● Occurs in 1 per 50,000 pregnancies
Sites
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● Pruritic lesions of abdomen, chest, back and extremities
Etiology
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● Due to circulating autoantibodies against placental collagen XVII, a hemidesmosomal transmembrane protein (J Cell Biochem 1999;72:356)
Clinical features
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● Usually urticarial papules, also blisters and rash
● Usually resolves within weeks to months after delivery
● Tends to recur with subsequent pregnancy
● ELISA serum testing may be more sensitive and specific than indirect immunofluorescence (Int J Dermatol 2008;47:1245)
Prognostic factors
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● Poor prognostic factors: onset in the first or second trimester and presence of blisters (Br J Dermatol 2009;160:1222)
Case reports
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● 29 year old woman with transfer to infant (Arch Gynecol Obstet 2009;279:235)
Treatment and prognosis
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● Oral and topical corticosteroids (J Am Acad Dermatol 2006;55:823)
Clinical images
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Abdominal lesions Exudative and erythematous lesions
Various images
Microscopic description (Histopathology)
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● Similar to bullous pemphigoid - subepidermal blister, with eosinophils in lumen
● Marked edema in papillary dermis
Micro images
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H&E and C3 Bullous pemphigoid Linear C3 staining
Virtual slides
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Herpes gestationis
Positive stains
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● Linear C3 deposits along cutaneous basement membrane; variable IgG deposition (Eur J Obstet Gynecol Reprod Biol 2009;145:138)
Differential diagnosis
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● Pruritic urticarial papules of pregnancy: typically begins in stretch mark areas of the abdomen and usually ends within 2 weeks after delivery; no antibody deposition
Additional references
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End of Skin - nontumor > Blistering disorders > Pemphigoid gestationis
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