What Is Pemphigoid Gestationis?

Pemphigoid gestationis (PG) is a rare autoimmune skin condition that typically occurs during pregnancy, although it can also occur in the days following birth and during menstrual cycles. Formerly known as herpes gestationis, it isn’t related to the herpes simplex virus. It occurs in approximately one in 50,000 pregnancies.

Even though it often resolves by itself after delivery, treatments are available. These treatments are meant to ease itching and prevent blister formation.

This article will discuss pemphigoid gestationis, its symptoms and causes, diagnosis, and treatments.

Pemphigoid Gestationis Symptoms

Symptoms of pemphigoid gestationis typically appear in the second trimester of pregnancy. But symptoms can also occur anytime in pregnancy, up to the days following birth.

It starts with a sudden itchy rash, including bumps or blisters, that may spread to other areas of the body. The itching is significant enough that it usually interferes with daily life.

Symptoms include:

• A red, itchy rash with plaques and papules appears around the belly button (both are elevated lesions, with plaques being larger in diameter and wider than they are thick).
• The rash may look like hives (raised welts with a clearly defined border).
• The rash may also be on the extremities, chest, back, buttocks, palms of hands, and soles of feet.
• Blisters may form after several weeks, and some may be in a circular formation.
  

Pemphigoid Gestationis Causes

Pemphigoid gestationis is caused by a person’s immune system attacking their body. The immune system produces autoantibodies (proteins that direct an attack on the person's skin). It is not definitively known what triggers autoantibody production.

PG is seen more in those who have other autoimmune conditions as well, like Graves’ disease.

Risk factors for pemphigoid gestationis include:

• Use of oral contraceptives ("the pill")
• Previous pregnancies with pemphigoid gestationis
• Menstrual cycles (pemphigoid gestationis can occur with them)
• Older age
• Having other autoimmune conditions

Diagnosing Pemphigoid Gestationis

Treatment of pemphigoid gestationis depends on accurate diagnosis. In order to diagnose pemphigoid gestationis, the healthcare provider will consider the person's medical history and physical examination.

A biopsy (sample) of the skin will be examined in the laboratory. However, it isn’t possible to distinguish pemphigoid gestationis from pruritic urticarial papules and plaques of pregnancy (PUPPP) microscopically. A blood test for serum levels of anti-BP180 antibodies can help make the diagnosis.

Pemphigoid Gestationis Treatment

Mild pemphigoid gestationis cases can be treated with topical steroids (medications applied to the skin), and moderate to severe cases are often treated with oral steroids. The lowest dosage of steroids should be used, to minimize any potential side effects to the individual and the fetus.

Other treatments can include vitamin B6 and first-generation antihistamines such as Benadryl (diphenhydramine).

For people who do not respond to typical treatment or for those who cannot take systemic corticosteroids, steroid-sparing agents like Intravenous immunoglobulin (IVIG) (a mixture of antibodies given through a line placed in a vein) and dapsone (an antibiotic sold under the brand name Aczone) can be used.

For severe pemphigoid gestationis, treatments given after childbirth can include:

• Intravenous immunoglobulin (IVIG)
• Plasmapheresis: A procedure in which the liquid part of the blood (plasma) is removed (along with circulating antibodies) and replaced, and then delivered back into your body through a vein, along with your blood cells
• Trexall (methotrexate): A drug that reduces the immune response
• Aczone (dapsone)
• Rituxin (rituximab): A monoclonal antibody used to treat autoimmune diseases
• Cytoxan (cyclophosphamide): Suppresses cells involved in the immune respone

Sometimes secondary bacterial infections occur, and these need to be treated with antibiotics.

While PG typically resolves on its own weeks to months after giving birth, some cases have lasted for years.

Summary

Pemphigoid gestationis is a rare skin condition that can be very uncomfortable. However, there are treatments available. If you notice a rash developing, especially during pregnancy, see your healthcare provider immediately. Treatment and management of pemphigoid gestationis can help provide much-needed relief.

A Word From Verywell

If you have a rash during pregnancy, book an appointment to see your healthcare provider immediately. There are several skin conditions that can occur during pregnancy, and it’s important to get an accurate diagnosis so that appropriate treatment can be given.