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Pemphigoid Gestationis

By

Antonette T. Dulay

, MD, Main Line Health System

Last full review/revision Aug 2019| Content last modified Aug 2019
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Pemphigoid gestationis is an intensely itchy rash that occurs only during pregnancy.

  • Typically, the rash starts around the navel, appears during the 2nd or 3rd trimester, and disappears within a few weeks or months after delivery.

  • Usually, the baby is unaffected, although some develop a similar rash, which disappears without treatment within a few weeks.

  • Doctors usually diagnose pemphigoid gestationis based on what the rash looks like.

  • The rash is treated with a corticosteroid cream or, if it is severe, with a corticosteroid taken by mouth.

Pregnancy complications, such as pemphigoid gestationis, are problems that occur only during pregnancy. They may affect the woman, the fetus, or both and may occur at different times during the pregnancy. However, most pregnancy complications can be effectively treated.

Pemphigoid gestationis is thought to be caused by abnormal antibodies that attack the body's own tissues—an autoimmune reaction. It is relatively rare.

Symptoms

The rash can begin as flat or raised red spots that often first form on the abdomen around the navel. Then blisters develop and the rash spreads. The blisters are small or large, irregularly shaped, and fluid-filled. The rash is extremely itchy. The rash can spread to the rest of the body, including the trunk, arms, legs, palms, and soles. The face and mouth are usually not affected.

The rash usually appears during the 2nd or 3rd trimester. However, it may appear earlier or immediately after delivery. Typically, the rash worsens soon after delivery and disappears within a few weeks or months. It often reappears during subsequent pregnancies and sometimes reappears if the woman later takes oral contraceptives. It can also reappear while women are having their periods or when the ovaries release an egg (at ovulation).

Usually, the baby is unaffected. But occasionally, the baby is born with a similar rash, which usually disappears without treatment within a few weeks. Also when women have pemphigoid gestationis, the risk of problems, including death of the baby, are increased if the baby is born prematurely or has not grown as much as expected (intrauterine growth restriction).

Diagnosis

  • A doctor's evaluation

  • Sometimes a skin biopsy

Pemphigoid gestationis is diagnosed based on the rash's appearance. Sometimes doctors take a sample of skin from the affected area (skin biopsy) and test it for abnormal antibodies.

Tests, such as a nonstress test, ultrasonography, or electronic fetal monitoring, may be done to evaluate the fetus.

Treatment

  • Corticosteroids

Applying a corticosteroid cream (such as triamcinolone) directly to the skin often helps relieve the itching.

For more widespread rashes, a corticosteroid (such as prednisone) is given by mouth.

Antihistamines that do not cause drowsiness, taken by mouth, can also be used to relieve the itching.

Drugs Mentioned In This Article

Generic Name Select Brand Names
KENALOG
RAYOS
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