Skin

Question 1

Incidence of pemphigoid gestationis?

Answer 1

Rare,1 /10,000 - 1/60,000

Question 2

Clinical features of pemhigoid gestationis?

Answer 2

• intensely pruiritc, urticaria papules, plaques, target lesion and wheels.
• vesicles and tense bullae may form after 2 wks
• lesions behind umbilically and spread outwards
• onset: any GA but USU in 3rd trimester

Question 3

What is the distribution of pemphigoid gestationis?

Answer 3

Starts periumbillically and spreads outwards to limbs, palms and soles

Question 4

Pathogenesis of herpes gestationis?

Answer 4

Aka pemphigoid

-Autoimmune origin possible due to exposure to fetal antigens.
——binding of IgG antibodies to the protein (bulbous pemphigoid Antigen 2) in the basement membranes of the skin, triggers an immune response, and formation of sub-epidermal vesicles.
- Assoc with bulbous pemphihoid
- Assoc with other autoimmune conditions (T1DM, vitiligo, pernicious anaemia, Graves’, RA)

Question 5

Course of disease (pemphigoid gestationis)?

Answer 5

• Onset usually in T3 (but can occur any time)
• improves at the end of pregnancy
• flares postpartum
• urticarial plaques may persist for a few months postdelivery.
• Some patients develop bulbous pemphigoid
• usually recurs in future pregnancies with earlier nonsense and more severe disease
  -COCPs may cause recurrence

Question 6

Diagnosis and treatment of pemphigoid gestationis?

Answer 6

Diagnosis made with skin biopsy and direct immunofluorescence
—shows direct complement deposition in the basement zone

• indirect immunofluorescence of the serum may yield antibodies in 30-100% of pts.

Treatment
*Potent topical corticosteroids
——-0.1% mometasone furoate
——0.05% clobetasol propionate

*Systemic corticosteroids is needed for most ppl and should be given in pregnancy .
*Some pts may need systemic immunosuppression
—tacrolimus and cyclosporin

• Sedative Antihistamines
  Chlorpheniramine 4mg tds/qid, promethazine/phenergan 25mg nocte