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Pemphigoid gestationis is a rare pregnancy-associated autoimmune skin disease that is characterised by an itchy rash that develops into blisters.
Pemphigoid gestationis is an autoimmune blistering disease, which basically means that an individual's immune system starts reacting against his or her own tissue.
In pemphigoid gestationis the target is a protein known as BPAG2 (also called BP180), found within the basement membrane, which is the zone between the epidermis and the dermis (the top and middle layers of skin).
The antibody attack results in inflammation and separation of the epidermis from the dermis allowing fluid to build up and create a blister.
Most patients present with an intensely itchy hive-like rash during mid to late pregnancy (13 to 40 weeks gestation).
Within days to weeks, the rash spreads to other parts of the body including the trunk, back, buttock, and arms. Diagnosis generally requires a skin biopsy, which shows typical features of subepidermal blistering, similar in microscopic appearance to bullous pemphigoid (BP) or epidermolysis bullosa acquisita (EBA). The primary aim of treatment is to relieve itching, prevent blister formation and treat secondary infections.

In most cases, pemphigoid gestationis resolves spontaneously within days after delivery so treatment can be tapered off and stopped. Send Home Our method Usage examples Index Contact StatisticsWe do not evaluate or guarantee the accuracy of any content in this site. BPAG2 is within the hemidesmosome, the cell component that sticks the epidermal keratinocyte cells to the dermis. Symptoms may lessen or spontaneously resolve towards the end of the pregnancy but this is short-lived, as 75-80% of women will experience a flare-up around delivery. Pemphigoid gestationis is confirmed by direct immunofluorescence staining of the biopsy to reveal antibodies. Topical corticosteroids are used in mild disease whilst oral corticosteroids are necessary in more extensive cases. Immunosuppressive medications such as azathioprine or ciclosporin may also be used successfully but their safety in pregnancy or during breast feeding must be carefully considered. It also affects non-pregnant females with tissue of placenta origin, such as choriocarcinoma; or hydatidiform mole.

It was previously known as herpes gestationis although it has no association with the herpes virus whatsoever.
In most cases, symptoms resolve days later after giving birth, however in some, the disease remains active for months or years. Minimum effective doses should be used to reduce the risk of side effects to both mother and fetus.
Commencement of menstrual periods, use of oral contraceptives or further pregnancies may cause flare-ups.
In some cases, circulating antibodies can be detected by a blood test (indirect immunofluorescence test).

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