Herpes Gestationis

Herpes Gestationis

 

Pemphigoid gestationis (herpes gestationis) is a rare disease of pregnancy and the puerperium.

Epidemiology

  • Incidence – 2/100,000 pregnancies
  • Age of onset – childbearing years
  • Gender – only females

Risk Factors

  • Previous pregnancy with herpes gestationis

Pathology and Immunopathology

  • Subepidermal blister
  • Linear C3 at the basement membrane zone on direct immunofluorescence of perilesional tissue in all cases; also linear IgG in 25%
  • Complement fixing IgG basement membrane zone antibodies (Herpes Gestationis Factor HGF) in serum in 50% showing epidermal localization on split skin substrate
  • IgG BP180 (BP Ag2) and, less commonly, IgG BP230 (BP Ag1) antibodies present

Clinical Presentation

  • Typically occurs in the second to third trimester and resolves within several weeks of delivery
  • Variable skin lesions ranging from urticarial to vesicles to tense blisters on skin
    • Often involves palms and soles
    • Usually spares mucosa
  • Pronounced pruritus
  • May reoccur during:
    • Subsequent pregnancies; may occur earlier and with greater severity
    • Menstrual cycles
    • Hormonal treatment
    • Molar pregnancy
  • Infants of affected mothers may be small and have lesions from transplacental antibodies

Diagnosis

  • Laboratory testing
    • Testing is highly sensitive and specific for pemphigoid (herpes) gestationis
      • Herpes gestationis factor by indirect immunofluorescence with fresh source of complement
      • Testing by ELISA for BP180 supplements testing by indirect immunofluorescence
        • BP180 (BP Ag2) has been identified as a major antigenic target; BP 230 (BP Ag1) is less commonly an antigenic target
  • Prompt, accurate diagnosis is essential for planning therapy to minimize morbidity and patient discomfort

Differential Diagnosis

  • Pruritic urticarial papules and plaques of pregnancy
  • Contact dermatitis
  • Dermatitis herpetiformis
  • Bullous or urticarial drug reaction

Treatment

  • Prednisone

Disease Monitoring

  • Antibody levels may be helpful but may lag behind clinical response and not reflect disease activity

See Also