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Herpes Gestationis

Pemphigoid Gestationis


Presentation

  • In three patients with immunologically verified disease, the clinical presentation consisted of widespread erythematous, edematous papules and plaques, grouped vesicles on erythematous bases, and tense bullae.[ncbi.nlm.nih.gov]
  • Tense bullae are present on the arms of this otherwise healthy 32-year-old primigravida woman.[emedicine.medscape.com]
Fever
  • While most people have their first herpes outbreak when they’re young, either in the form of oral herpes symptoms presenting a cold sore or fever blister as with herpes labialis, others had chicken pox as school children.[skincarearticles.com]
  • Approximately five out of 10,000 pregnant women have varicella (chickenpox). 7 It causes fever and a disseminated pruritic, vesicular, umbilicated rash with crusted lesions.[aafp.org]
  • Generalized symptoms such as fever and malaise may develop, and lymph nodes in the groin may enlarge. Lesions may persist in this stage for a week or more, and complete healing may take four to six weeks.[britannica.com]
  • Treatment includes medication for fever (see above, anti-inflammatory drugs) and taking plenty of fluids.[emedicinehealth.com]
Malaise
  • Generalized symptoms such as fever and malaise may develop, and lymph nodes in the groin may enlarge. Lesions may persist in this stage for a week or more, and complete healing may take four to six weeks.[britannica.com]
  • Med J Aust 2002; 176 (11): 595-596. doi: 10.5694/j.1326-5377.2002.tb04565.x Published online: 17 June 2002 Clinical Record A 30-year-old woman in the 30th week of pregnancy was admitted with a two-day history of fever, malaise, dysuria, frequent micturition[mja.com.au]
  • Patients feel unwell and may complain of fatigue, malaise, fevers, chills, nausea, vomiting or diarrhea. Pustular psoriasis of pregnancy tends to remit upon delivery but occasionally flares postpartum.[cancertherapyadvisor.com]
  • Systemic symptoms are severe and include malaise, fever, anorexia, nausea, vomiting, diarrhea, and tetany [ 68,69 ]. Leukocytosis and elevated erythrocyte sedimentation rate are common.[uptodate.com]
Blister
  • In many areas of blister formation sub-basal dense plates, but probably also the upper parts of the hemidesmosomes were separated from the roof of the blister.[ncbi.nlm.nih.gov]
  • It was originally called herpes gestationis because of the blistering appearance, although it is not associated with the herpes virus.[en.wikipedia.org]
Pruritus
  • It is a rare vesiculo-bullous eruption that develops during the last trimester or even postpartum and creates severe pruritus.[ncbi.nlm.nih.gov]
  • Only very rarely (5%) a pregnancy may be passed over Pemphigoid gestationis presents with intense pruritus that occasionally may precede the manifestation of skin lesions initially, erythematous urticarial papules and plaques typically develop on the[gpnotebook.co.uk]
  • Nonsedating oral antihistamines can also be used to relieve pruritus. Pemphigoid gestationis probably has an autoimmune etiology, even though the rash resembles the vesicobullous rash due to herpes simplex virus infection.[msdmanuals.com]
Urticaria
  • […] urticarial papules and plaques of pregnancy (PUPPP) Atopic eruption of pregnancy – also known as prurigo gestationis (prurigo of pregnancy or PP) and pruritic folliculitis of pregnancy Intrahepatic cholestasis of pregnancy Viral exanthems (eg, varicella ) Urticaria[arupconsult.com]
  • Differential Diagnosis (Other conditions with similar appearance) Bullous pemphigoid Cicatricial pemphigoid Linear IgA dermatosis Pruritic urticarial papules and plaques of pregnancy Urticaria, Acute Diagnosis Key Points *Initial diagnosis based on appearance[ozarkderm.com]
  • They differ from true urticaria because they are relatively fixed in nature. The rash spreads peripherally, often sparing the face, palms and soles. Mucosal lesions occur in fewer than 20% of cases.[patient.info]
Excoriation
  • They were manifested by a polymorphous eruption, consisting of erythematous urticaria-like plaques, small tense vesicles and multiple excoriations. Mucous membranes were not affected. Routine laboratory examinations were within normal limits.[journal-imab-bg.org]
  • ICP may present with secondary skin changes such as excoriations and excoriated papules from scratching, or may present with pruritus alone.[cancertherapyadvisor.com]
  • With excoriations, there can be oozing, weeping, and secondary bacterial infection.[glowm.com]
  • It is characterized by maternal pruritus affecting the palms and soles, and increased rates of preterm labor and adverse fetal outcomes. 4, 5 There are no dermatologic features, except for excoriation from the pruritus.[aafp.org]
Eczema
  • Eczema in pregnancy and prurigo of pregnancy tend to start and often remain on the extremities.[cancertherapyadvisor.com]
  • (See "Management of psoriasis in pregnancy" and "Treatment of atopic dermatitis (eczema)" .)[uptodate.com]
  • Pruritus is the leading symptom in the pregnancy-specific dermatoses, but pruritus also occurs in more common diseases such as urticaria, drug hypersensitivity reactions, contact dermatitis and other eczemas, pityriasis rosea, pityriasis versicolor, and[dovepress.com]
  • Rarely, some complications develop in a few individuals: Atopic eczema Encephalitis Keratoconjunctivitis Pharyngitis Hepatitis Herpes whitlow (HSV blisters or lesions on the finger[s]) Oral Herpes vs. Canker Sores Cancer sores are not contagious.[emedicinehealth.com]
  • Atopic dermatitis Atopic dermatitis (atopic eczema) is a chronic inflammatory skin condition with itching. There are no primary lesions, but secondarily, there is erythema, scaling, lichenification, and sometimes papules.[glowm.com]
Denial
  • […] gestationis (herpes gestationis). ( 26057509 ) Argueta E.E....Tschen J.A. 2015 30 Positive clinical outcome with IVIg as monotherapy in recurrent pemphigoid gestationis. ( 25765353 ) Nguyen T....Razzaque Ahmed A. 2015 31 Pemphigoid gestationis revealing a denial[malacards.org]
  • Wolkenstein, Pemphigoid gestationis revealing a denial of pregnancy, Journal of the European Academy of Dermatology and Venereology, 30, 8, (1411-1413), (2015).[doi.org]
Amenorrhea
  • A 24-year-old secundigravida presented at 38 weeks of amenorrhea with typical cutaneous lesions of herpes gestationis. The newborn developed a skin rash 3 days after birth.[ncbi.nlm.nih.gov]
Headache
  • An initial infection starts after an incubation period of 3-7 days, after which fever, headaches, fatigue and muscle pains can occur.[americanskin.org]
  • Possible side-effects of aciclovir include skin rash, light sensitivity, headache, dizziness, tummy upset and tirednesss.[netdoctor.co.uk]
  • […] appetite, but there is no evidence of an increased risk of adverse pregnancy outcome. 46 Use of cyclosporine A is associated with multiple side effects such as high blood pressure, renal insufficiency, bone marrow suppression, increased hair growth, headache[dovepress.com]
  • The first set symptoms are: Itching sensations Burning sensations Tingling sensations Sores/Blisters Lesions Discharge – vaginal Painful urination Swollen lymph nodes in the groin area Flu-like symptoms – fever, headaches, muscle aches Some of these symptoms[herpeshelper.net]
  • Common signs and symptoms of STIs include: Flu-like symptoms, including headache and fatigue (feeling very tired) Vaginal discharge or burning, itching, redness or swelling in the vaginal area Pain, itching or burning when you go to the bathroom; pain[marchofdimes.org]

Workup

  • Biopsy and immunohistology are both used in the workup of the disease.[arupconsult.com]
Colitis
  • She also had Graves' disease, alopecia totalis and ulcerative colitis. The case demonstrates the close overlap between herpes gestationis and bullous pemphigoid.[ncbi.nlm.nih.gov]
HLA-DR2
  • In addition, anti-HLA-DR2 antibodies were present in serum samples taken from this patient.[ncbi.nlm.nih.gov]
  • […] million people Age – onset in childbearing years Sex – exclusively females Ethnicity – no racial distribution Risk Factors Previous pregnancy with pemphigoid gestationis HLA-DR3, HLA-DR4, or both DRB1*0301 and DRB1*0401/040X C4 null allele Increased HLA-DR2[arupconsult.com]
  • Indeed, a slight increase in HLA-DR2 in the husbands of women with PG has been reported. 23 It has been suggested that immunologically primed women may simply react more strongly to tissue with disparate HLA antigens.[dermaamin.com]
HLA-B8
  • In herpes gestationis, immunofluorescence studies were consistently positive, there was a high frequency of HLA-B8 and an association with autoimmune thyrotoxicosis. Toxic erythema of pregnancy did not share these immunological features.[ncbi.nlm.nih.gov]
HLA-B8
  • In herpes gestationis, immunofluorescence studies were consistently positive, there was a high frequency of HLA-B8 and an association with autoimmune thyrotoxicosis. Toxic erythema of pregnancy did not share these immunological features.[ncbi.nlm.nih.gov]
HLA-A1
  • Immunogenetic studies reveal an increase in HLA antigens DR3 or DR4, and curiously, nearly 50 percent of patients have the simultaneous presence of both. 21 The extended haplotype HLA-A1, B8, DR3 is known to be in linkage disequilibrium with a deletion[dermaamin.com]
HLA-B5
  • The more serious case (widespread cutaneous involvement, repeated fetal deaths) had a very powerful anti-HLA-A9 anti-HLA-B5 antibody (titre 1/1000); the other had less severe skin lesions; she had an anti-HLA-B13 antibody (titre was 1/256).[ncbi.nlm.nih.gov]

Treatment

  • No significant associations of adverse pregnancy outcomes with autoantibody titre or systemic corticosteroid treatment were found.[ncbi.nlm.nih.gov]
  • In the post partum period, if necessary, the full range of immunosuppressive treatment may be administered for cases unresponsive to corticosteroid treatments, such as tetracyclines, nicotinamide, cyclophosphamide, ciclosporin, goserelin, azathioprine[en.wikipedia.org]

Prognosis

  • The incidence, classification, aetiology, natural history, diagnosis, prognosis and therapy of the disease are briefly discussed.[ncbi.nlm.nih.gov]
  • Mechanism and pathophysiology autoimmune bullous dermatosis pathophysiology antibodies against hemidesmosomal proteins undetermined trigger Associated conditions other autoimmune diseases such as Hashimoto's thyroiditis Grave's disease pernicious anemia Prognosis[medbullets.com]

Etiology

  • Its etiology is unknown, but it is considered as an autoimmune-mediated dermatosis closely related to the pemphigoid group.[ncbi.nlm.nih.gov]
  • Etiology and pathophysiology are not established, but an immunological basis is implicated by the frequent finding of C 3 along the basement membrane zone of perilesional skin, the presence of herpes gestationis factor, increased incidence of HLA-DR3[jhu.pure.elsevier.com]
  • The etiology of herpes gestationis is uncertain.[popline.org]

Epidemiology

  • Patient Population: Prevalence and Epidemiology Knee // Shoulder & Elbow // Hip // Spine // Foot & Ankle // Hand & Wrist Fragility Fractures: Diagnosis and Treatment Shoulder & Elbow The Characteristics of Surgeons Performing Total Shoulder Arthroplasty[amjorthopedics.com]
  • […] blistering dermatologic disorder unique to pregnancy NOT associated with past or present herpes infection onset T2-postpartum characterized by severe pruritis lesions are erythematous papules, vesicles, and bullae distribution abdomen extremities generalized Epidemiology[medbullets.com]
Sex distribution
Age distribution

Pathophysiology

  • However, because no control bullous pemphigoid sera showed this reactivity, it may suggest a different pathophysiology between herpes gestationis and bullous pemphigoid.[ncbi.nlm.nih.gov]
  • Etiology and pathophysiology are not established, but an immunological basis is implicated by the frequent finding of C 3 along the basement membrane zone of perilesional skin, the presence of herpes gestationis factor, increased incidence of HLA-DR3[jhu.pure.elsevier.com]
  • […] autoimmune bullous dermatosis pathophysiology antibodies against hemidesmosomal proteins undetermined trigger Associated conditions other autoimmune diseases such as Hashimoto's thyroiditis Grave's disease pernicious anemia Prognosis increased incidence[medbullets.com]

Prevention

  • […] relief of symptoms and the prevention of secondary infection.[ozarkderm.com]
  • Your doctor may increase your steroid dose in late pregnancy to help prevent this from happening. There is a risk that pemphigoid gestationis will affect your baby.[babycentre.co.uk]
  • The dose of steroid tablets may need to be increased at the end of pregnancy to prevent the condition flaring after delivery.[transmed.co.za]
  • The primary aim of treatment is to relieve itching, prevent blister formation and treat any secondary infection. Topical steroid creams can be used in mild cases if only a limited area of skin is affected.[skinsupport.org.uk]
  • […] for fetus increase in prematurity and small-for-date babies neonatal pemphigus is a rare complication of pregnancy in pemphigus patients Treatment seek expert advice depends on the stage and severity of the disease and aims to control pruritus and to prevent[gpnotebook.co.uk]

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