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Interesting Facts of Herpes Gestationis
- Herpes gestationis (gestational pemphigoid, pemphigoid gestationis) is an autoimmune bullous condition caused by IgG antibodies directed primarily against BPAg2 (occasionally BPAg1), a structure necessary for adherence of the epidermis to the basement membrane zone. The clinical presentation of a pregnant or recently pregnant woman who presents with a sudden onset of fixed red plaques, with or without blisters, is highly suggestive of the diagnosis.
- A punch biopsy of lesional skin should be done for routine histologic examination. The findings are diagnostic not only of herpes gestationis but also can strongly support and exclude other clinical possibilities.
- Treatment of choice is corticosteroids. Because the disease is generally self-limited and resolves over a period of days, weeks, or months after delivery, the therapy usually does not have to be sustained.
- Most cases resolve in the postpartum period, usually over days, weeks, or months. Occasional cases may persist for years or be perpetuated by use of oral contraceptives. Although early studies have suggested an adverse effect on the fetus, more recent studies have concluded that there is usually no adverse effect on the fetus.
- Herpes gestationis may be transmitted to the neonate, but this is very rare. Neonates with herpes gestationis experience spontaneous resolution within weeks after birth as the maternal antibodies are lost.
What causes this condition and what increases the risk?
- Herpes gestationis (gestational pemphigoid, pemphigoid gestationis) is an autoimmune bullous condition caused by IgG antibodies directed primarily against BPAg2 (occasionally BPAg1). BPAg1 is a structure necessary for adherence of the epidermis to the basement membrane zone. It is, in essence, BP occurring in gravid or recently gravid women.
- The condition occurs nearly exclusively during pregnancy or shortly thereafter and is less often associated with trophoblastic malignancy or molar pregnancy.
What is the incidence of this condition?
- The incidence has been calculated to be anywhere from 1: 3,000 to 1: 60,000 pregnancies.
How is Herpes Gestationis diagnosed?
Approach to Diagnosis
- The clinical presentation of a pregnant or recently pregnant woman who presents with a sudden onset of fixed red plaques, with or without blisters, is highly suggestive of the diagnosis.
Workup
What History needs to be elicited?
- The condition affects pregnant women or recently pregnant women. The disease usually occurs in the latter portion of pregnancy or following delivery.
Physical Examination
- Lesions can be fixed, red, urticarial plaques, tense blisters, or a combination of these two primary lesions.
- Characteristic areas of involvement include the intertriginous and periumbilical areas.
- The symptoms are typically pruritic.
What are the Diagnostic Procedures
- A punch biopsy of lesional skin should be done for routine histologic examination. The findings are diagnostic not only of herpes gestationis but also can strongly support and exclude other clinical possibilities.
- A biopsy of perilesional skin should be performed for DIF studies. Linear deposition of C3, with or without IgG, at the dermoepidermal junction is diagnostic in this context.
How is this condition treated?
Nondrug and Supportive Care
- Rare patients may demonstrate disease for years afterward, and steroid-sparing agents are used.
Drug Therapy
- Treatment of choice is corticosteroids (e.g., oral prednisone, with a usual initial dose being 40 to 60 mg). Because the disease is generally self-limited and resolves over a period of days, weeks, or months after delivery, the therapy usually does not have to be sustained.
References
Fitzpatrick JE, High WA. Urgent Care Dermatology: Symptom-Based Diagnosis. Philadelphia PA: Elsevier Inc; 2018. Cross Reference
