Pemphigoid gestationis in a multigravida, EDOJ 8 (2): 6

Pemphigoid gestationis in a multigravida, EDOJ 8 (2): 6

Intravenous immunoglobulin (IVIG) is a blood product derived from the pooled plasma of about 10,000 to 20,000 individuals. According to her mother, the newborn was thriving and had had no behavioral changes coincident with the onset of the rash. It can occur in any pregnancies but 50% is in the first pregnancy. Atopic eruption of pregnancy is the most common of these disorders. Within hours after her first delivery, pruritic reddish raised lesions appeared over the abdomen and limbs. Increased hair growth with ensuing postpartum hair loss. But recent studies have proven that many pregnancy rashes for example the Pruritic Urticarial Papules and Plaques of Pregnancy better known as PUPPP is definitely not a product of hormonal shifts, many believe that it occurs due to the fetal cell’s contact with the mother it can also be traced to the genetic patterns obtained from the father’s side.

It can be diagnosed by histopathology and direct immunofluorescence which is confirmatory. Urticarial plaques were also seen. Use a moisturising lotion, cream or ointment to protect your skin. Most of available literature concerning this problem is based on case reports or reports of small numbers of women. as fetal deaths before and after 24 completed weeks of gestation, respectively[9]), congenital malformation (excluding chromosomal and genetic syndromes as unlikely to be attributable to PG or drug exposure), and mode of delivery (normal vaginal delivery, assisted delivery, or caesarean section). Our series is comparable to the literature: the late occurrence of PG during the course of pregnancy, the high frequency of multigravida women, the lack involvement in the newborn, however with some particularities: the frequent involvement of the face and the efficiency of dapsone. Cutaneous histologic examination revealed a sub-epidermal blister in 11 cases and a lymphohistiocyte infiltrate in all cases.

There was no significant family or drug history. Physical examination revealed bilaterally distributed erythematous papules and plaques with a few target lesions and multiple tense bullae and yellow crusted plaques on both forearms, diffuse vesicular plaques over whole trunk including neck and multiple erythematous papules on the thighs. However, PG is an extremely rare disease, and we have tried to overcome this limitation by recruiting study subjects from three sources. Fade skin pigmentation and dark spots. The lesions typically start around the navel before spreading all over. The vast majority of the patients (61%) became free of symptoms within 1-2 months of treatment. Pemphigoid gestationis is a bullous autoimmune sub-epidermal dermatosis, occurring during pregnancy and/or postpartum.

They tend to come in crops, just as one batch starts to go away, another crops up. The patient was treated by oral prednisolone 40 mg daily for 1 week and tapering 5mg every 5 days until a maintenance dosage of 20 mg daily was achieved. The patient was also given chlorpheniramine 25 mg thrice daily and topical mupirocin ointment for the crusted areas. The patient was on regular follow up and maintenance dose of 20 mg daily till she delivered and postpartum for 1 month. This works as an antiseptic for wounds, bites, burns, and rashes. As an example, one study demonstrated fetal DNA in maternal skin lesions. Some make it easier for white blood cells to destroy antigens.

Pemphigoid gestationis in a multigravida, EDOJ 8 (2): 6
If you have (or have ever had) angina pectoris (a condition that causes severe chest pain and may be a first sign of a heart attack), or transient ischaemic attack (TIA) – temporary stroke symptoms. PG is a rare disease with an incidence of 1 in 50,000 to 60,000 pregnancies [5]. Yes. The PG antigen is located in the basement membrane of normal skin and in the basement membrane zone of amniotic epithelium of both the placenta and umbilical cord [7]. There appears to be a genetic basis for the development of PG with HLA-DR3 and DR4. Because choriocarcinoma in women is entirely derived from placental tissue (which is largely of paternal derivation), the suggestion is that the development of PG is somehow dependent on the state of partial allograph, not necessarily on the presence of amnion. See also Notes and References Ambros-Rudolph CM, Müllegger RR, Vaughan-Jones SA, Kerl H, Black MM.

Since food allergies may trigger atopic dermatitis, the doctor may suggest eliminating certain foods from the diet if other treatments prove ineffective. In 25% to 30% of cases, IgG deposition also can be found along basement membrane [9]. Powell et al [10] demonstrated that a serological test measuring the major immunoreactive portion of the NC 16A domain of BP 180 antigen can be used to verify the diagnosis of PG and differentiate it from PUPPP. Intense pruritus is the consistent hallmark of PG, while the clinical course is variable. PG typically presents during the second or third trimester with a mean onset of 21 weeks but may develop in the first trimester, the time of delivery [6], the first postpartum month [11], and with the onset of menses or the use of oral contraceptives in the postpartum period [12]. Improvement is seen following delivery with no postnatal exacerbation. The PG lesions characteristically begin peri-umbilically and then spread outward to include the buttocks, trunk and extremities, sparing the mucous membranes, face, palms and soles [13].

Patients with PG should be identified as a high-risk pregnancy and be followed accordingly. Direct immunofluorescence of PG reveals linear IgG1 and IgG3 along the BMZ. Five to 10% of neonates have a transient sub-epidermal blistering that resolves on its own with no sequelae [14]. Systemic corticosteroids remain the mainstay of treatment in the low dosage of 20- 60mg daily but higher dosages up to 180 mg daily have been reported [11]. Maintenance therapy, generally at a lower dosage, may be required throughout gestation and postpartum. Antipruritic drugs help to alleviate pruritus. Dapsone, sulfapyridine, gold, cyclosporine, methotrexate, cyclophosphamide, azathioprine, pyridoxine, IV immunoglobulins and plasmapheresis have been tried with variable results.

In conclusion, PG is an autoimmune disease occurring almost exclusively during pregnancy. Its clinical course is variable but eruptions typically respond to steroid therapy. It is important to diagnose and treat PG early, not only to provide symptomatic relief to patients but to avoid fetal risks. It normally starts in the second trimester and will resolve postpartum although this may take several weeks. Engineer L, Bhol K, Ahmad AR. Pemphigoid gestationis: a review. AM J Obstet Gynecol 2000; 183: 483- 491.

2. Tillman WG. Herpes gestationis with hydatidiform mole and chorion epithelioma. Br Med J 1950; 1: 1471. 8. Fabbri P, Caproni M, Berti S, Bianchi B, Amato L, De Pita O, et al. The role of T lymphocytes and cytokines in the pathogenesis of pemphigoid gestationis.

Br J Dermatol 2003; 148: 1141-8. 10. Powell AM, Sakuma-Oyama Y, Oyama N, Albert S, Bhogal B, Kaneko F, et al. Usefulness of BP 180 NC16A enzyme -linked immunosorbent assay in the serodiagnosis of pemphigoid gestationis (HG) and differentiating between pemphigoid gestationis and pruritic urticarial papules and plaques of pregnancy. Arch Dermatol 2005; 141: 705-710.

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