Pemphigoid Gestationis

Synonym: Herpes gestationis. Clinical:

■ PG is a blistering disorder of young women during late pregnancy (last trimester) or in the early postpartum period. It can be exacerbated by oral contraceptives and by repeat pregnancy with same partner

■ PG is characterized clinically by urticarial plaques or wheals that evolve to vesicles and bullae (Fig. 4A). The eruption begins in the periumbilical area. About 5% of neonates born to mothers with pemphigoid gestationis may develop transient blisters.

Histology (Figs. 4C andD):

■ Subepidermal blister with eosinophils; can resemble bullous pemphigoid

■ Necrotic basal keratinocytes occasionally (not seen in bullous pemphigoid)

■ Usually more subtle than bullous pemphigoid

Differential Diagnosis:

Bullous pemphigoid; mucous membrane pemphigoid; EBA

Immunofluorescence:

■ DIF: C3 at the basement membrane zone (Fig. 4B)

■ IIF: Routine IIF usually negative. However, a special complement fixing IIF study is usually positive

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