Pemphigoid gestationis – a rare disease encountered in pregnancy

Abstract

Pemphigoid gestationis is a specific autoimmune disease of pregnancy. The onset occurs most commonly in the second or third trimester of pregnancy. Initially, the clinical picture is difficult to distinguish from polymorphic urticarial papules and plaques of pregnancy, urticarial plaques being present in both. Afterwards, the lesions form tense vesicles and bullae on an erythematous base. Direct immunofluorescence reveals C3 linear deposits, with or without IgG deposits along the basement membrane zone. Circulating antibodies are directed primarily against type XVII collagen (BP 180). The main fetal risks are preterm birth and fetal growth restriction. The treatment may be harmful for the fetus. Mild and moderate topical corticosteroids should be used. Systemic corticotherapy, azathioprine or dapsone should be administered in severe cases. Disease activity and treatment efficacy may be evaluated by measuring antibodies titer.