Clinician's Photo Guide to Recognizing and Treating Skin Diseases in Women: Part 2. Pregnancy-Related Dermatoses

, University of Singapore in Singapore, National Skin Centre in Singapore

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Pemphigoid Gestationis

PG is an antibody-mediated, organ-specific autoimmune disorder. With an estimated incidence of 1 in 50,000 pregnancies, it is considered uncommon. However, a recent report appears to indicate that the condition may be underdiagnosed, especially if skin biopsy and direct immunofluorescence studies are not performed.

The clinical presentation of PG involves eruption of vesiculobullous lesions, which initially occur around the umbilicus and then spread to other parts of the body (Fig. 1). The skin eruption is pruritic and may be associated with extensive erosions and exfoliation. Differential diagnoses include drug eruption, chicken-pox, erythema multiforme and acute contact dermatitis.

The condition is confirmed by skin biopsy; immunofluorescence study has shown antibody activity against the basement membrane components of the skin.

Figure 1. Pemphigoid gestationis involves eruption of vesiculobullous lesions, appearing initially around umbilicus and spreading to other parts of body.

Treatment. The treatment of choice for PG is systemic steroids, to be taken until the lesions clear. If the blistering eruptions are severe, an extensive oral prednisolone should be administered during any trimester of pregnancy. The dosage of systemic steroids should be reduced to the minimum level that controls occurrence of the blistering eruption. General nursing care consists of treatment of the skin erosions with topical antibiotics to prevent secondary infection and with topical steroids to control inflammation. Women with PG tend to go into remission after delivery, but may experience a recurrence with subsequent pregnancies or with use of oral contraceptives.

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