Pemphigoid Gestationis in a 15 Year Old Pregnant Patient, A Case Report and Literature Review

Emile Dabaj; Jana Abdo; Stephanie Yacoub; Rawad Halimeh; Zarouhie Bedoyan; Joe Khalifeh

doi:doi:10.11648/j.jgo.20190702.14

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Pemphigoid Gestationis in a 15 Year Old Pregnant Patient, A Case Report and Literature Review

Emile Dabaj, Jana Abdo, Stephanie Yacoub, Rawad Halimeh, Zarouhie Bedoyan, Joe Khalifeh

Published in Journal of Gynecology and Obstetrics (Volume 7, Issue 2)

Received: 5 February 2019 Accepted: 25 March 2019 Published: 8 May 2019

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Abstract

Pemphigoid gestationis, previously known as herpes gestationis, is a rare autoimmune bullous disease that manifests in pregnancy. Upon presentation, patients complain of intense pruritis, urticarial plaques, vesicles and bullae that primarily affect the peri-umbilical area before spreading to involve the rest of the body. The accurate diagnosis of pemphigoid gestationis is made histopathologically on biopsies, based on the presence of sub-epidermal vesicles, as well as direct visualization of linear deposition of C3 at the basement membrane zone by using immunofluorescence staining on those biopsies. The mainstay treatment of the disease remains corticosteroids. Prompt recognition and provision of the appropriate management allow a reduction in both maternal morbidity as well as fetal adverse perinatal outcomes. Pathologic skin dermatoses and diseases of pregnancy are rare and have different presentations, treatment and prognoses. This literature review includes an up to date comparison on the presentation, diagnosis and treatment of dermatoses in pregnancy, in order to help with the discrimination. A case of pemphigoid gestationis in a 15 year old woman is described. This is the youngest reported age of presentation of pemphigoid gestationis, raising the question of whether maternal age is a factor that can affect the course and the severity of the disease.

Published in	Journal of Gynecology and Obstetrics (Volume 7, Issue 2)
DOI	10.11648/j.jgo.20190702.14
Page(s)	46-50
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Pemphigoid Gestationis (PG), Herpes Gestationis, Pregnancy, Pruritis, Autoimmune, Major Histocompatibility Complex (MHC)

References

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[2]	Semkova K., Black M. Pemphigoid gestationis: current insights into pathogenesis and treatment. European Journal of Obstetrics Gynecology and Reproductive Biology. 2009; 145(2):138–144. doi: 10.1016/j.ejogrb.2009.05.012.
[3]	Shornick JK, Meek TJ, Nesbitt LT Jr, Gilliam JN: Herpes gestationis in blacks. Arch Dermatol 1984, 120(4):511–513.
[4]	Kolodny RG. Herpes gestationis: a new assessment of incidence and foetal prognosis. Am J Obstet Gynecol 1969; 104:39-45.)
[5]	G. diZenzo, V. Calabresi, F. Grosso, M. Caproni, M. Ruffelli, and G. Zambruno, “The intracellular and extracellular domains of BP180 antigen comprise novel epitopes targeted by pemphigoid gestationis autoantibodies,” Journal of Investigative Dermatology, vol. 127, no. 4, pp. 864–873, 2007.
[6]	Boulinguez S, Bedane C, Prost C, Bernard P, Labbe L, Bonnetblanc JM: Chronic pemphigoid gestationis: comparative clinical and immunopathological study of 10 patients. Dermatology 2003, 206(2):113–119.
[7]	Kelly SE, Black MM, Fleming S: Pemphigoid gestationis: a unique mechanism of initiation of an autoimmune response by MHC class II molecules? J Pathol 1989, 158(1):81–82.
[8]	L. Engineer, K. Bhol, and A. R. Ahmed, “Pemphigoid gestationis: a review,” The American Journal of Obstetrics and Gynecology, vol. 183, no. 2, pp. 483–491, 2000.
[9]	Hönigsmann H, Stingl G, Holubar K, e t al. Herpes gestationis: fine structural pattern of immunoglobulin deposits in the skin in vivo. J Invest Dermatol 1976; 66: 389 – 92.
[10]	Holmes RC, Black MM, Jurecka W, Dann J, James DC, Timlin D, Bhogal B: Clues to the aetiology and pathogenesis of herpes gestationis. Br J Dermatol 1983, 109(2):131–139.
[11]	J. K. Shornick and M. M. Black, “Secondary autoimmune diseases in herpes gestationis (pemphigoid gestationis),” Journal of the American Academy of Dermatology, vol. 26, no. 4, pp. 563– 566, 1992. (26)
[12]	Roth M. Pregnancy dermatoses: diagnosis, management, and controversies. American Journal of Clinical Dermatology. 2011; 12(1):25–41. doi: 10.2165/11532010-000000000-00000.
[13]	M. F. Cobo, C. G. Santi, C. W. Maruta, andV. Aoki, “Pemphigoid gestationis: clinical and laboratory evaluation,” Clinics, vol. 64, no. 11, pp. 1043–1047, 2009.
[14]	Rudolph CM, Al-Fares S, Vaughan-Jones SA, Mullegger RR, Kerl H, Black MM: Polymorphic eruption of pregnancy: clinicopathology and potential trigger factors in 181 patients. Br J Dermatol 2006, 154(1):54–60.
[15]	Beard MP, Millington GW: Recent developments in the specific dermatoses of pregnancy. Clin Exp Dermatol 2012, 37(1):1–4.
[16]	Ambros Rudolph CM: Schwangerschaftsspezifische Dermatosen: S04/05. J Dtsch Dermatol Ges 2011, 9(Sup 1):45–46.
[17]	R. C. Kolodny, “Herpes gestationis. A new assessment of incidence, diagnosis, and fetal prognosis,” American Journal of Obstetrics & Gynecology, vol. 104, no. 1, pp. 39–45, 1969.
[18]	Al-Fouzan AW, G aladari I, Oumeish I, e t al. Herpes gestationis (Pemphigoid gestationis). Clin Dermatol 2006; 24: 109 – 12.
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[21]	Aoyama Y, Asai K, Hioki K, Funato M, Kondo N, Kitajima Y. Herpes gestationis in a mother and newborn: immunoclinical perspectives based on a weekly follow-up of the enzyme-linked immunosorbent assay index of a bullous pemphigoid antigen noncollagenous domain. Arch Dermatol. 2007; 143:1168-72
[22]	Sitaru C, Dahnrich C, Probst C, Komorowski L, Blocker I, Schmidt E, Schlumberger W, Rose C, Stocker W, Zillikens D: Enzyme-linked immunosorbent assay using multimers of the 16th non-collagenous domain of the BP180 antigen for sensitive and specific detection of pemphigoid autoantibodies. Exp Dermatol 2007, 16(9):770–777.
[23]	Yancey KB. Herpes gestationis. Dermatol Clin 1990; 8:727-34.
[24]	Gan DC, Welsh B, Webster M: Successful treatment of a severe persistent case of pemphigoid gestationis with antepartum and postpartum intravenous immunoglobulin followed by azathioprine. Australas J Dermatol 2012, 53(1):66–69.
[25]	Castle SP, Mather-Mondrey M, Bennion S, David-Bajar K, Huff K. Chronic herpes gestationis and antiphospholipid antibody syndrome successfully treated with cyclophosphamide. J Am Acad Dermatol 1996; 34:333-6.
[26]	L. R. A. Intong and D. F. Murrell, “Pemphigoid gestationis: current management,” Dermatologic Clinics, vol. 29, no. 4, pp. 621–628, 2011.
[27]	C.-C. Chi, S.-H. Wang, R. Charles-Holmes et al., “Pemphigoid gestationis: early onset and blister formation are associated with adverse pregnancy outcomes,” British Journal of Dermatology, vol. 160, no. 6, pp. 1222–1228, 2009.
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APA Style

Emile Dabaj, Jana Abdo, Stephanie Yacoub, Rawad Halimeh, Zarouhie Bedoyan, et al. (2019). Pemphigoid Gestationis in a 15 Year Old Pregnant Patient, A Case Report and Literature Review. Journal of Gynecology and Obstetrics, 7(2), 46-50. https://doi.org/10.11648/j.jgo.20190702.14

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ACS Style

Emile Dabaj; Jana Abdo; Stephanie Yacoub; Rawad Halimeh; Zarouhie Bedoyan, et al. Pemphigoid Gestationis in a 15 Year Old Pregnant Patient, A Case Report and Literature Review. J. Gynecol. Obstet. 2019, 7(2), 46-50. doi: 10.11648/j.jgo.20190702.14

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AMA Style

Emile Dabaj, Jana Abdo, Stephanie Yacoub, Rawad Halimeh, Zarouhie Bedoyan, et al. Pemphigoid Gestationis in a 15 Year Old Pregnant Patient, A Case Report and Literature Review. J Gynecol Obstet. 2019;7(2):46-50. doi: 10.11648/j.jgo.20190702.14

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@article{10.11648/j.jgo.20190702.14,
  author = {Emile Dabaj and Jana Abdo and Stephanie Yacoub and Rawad Halimeh and Zarouhie Bedoyan and Joe Khalifeh},
  title = {Pemphigoid Gestationis in a 15 Year Old Pregnant Patient, A Case Report and Literature Review},
  journal = {Journal of Gynecology and Obstetrics},
  volume = {7},
  number = {2},
  pages = {46-50},
  doi = {10.11648/j.jgo.20190702.14},
  url = {https://doi.org/10.11648/j.jgo.20190702.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jgo.20190702.14},
  abstract = {Pemphigoid gestationis, previously known as herpes gestationis, is a rare autoimmune bullous disease that manifests in pregnancy. Upon presentation, patients complain of intense pruritis, urticarial plaques, vesicles and bullae that primarily affect the peri-umbilical area before spreading to involve the rest of the body. The accurate diagnosis of pemphigoid gestationis is made histopathologically on biopsies, based on the presence of sub-epidermal vesicles, as well as direct visualization of linear deposition of C3 at the basement membrane zone by using immunofluorescence staining on those biopsies. The mainstay treatment of the disease remains corticosteroids. Prompt recognition and provision of the appropriate management allow a reduction in both maternal morbidity as well as fetal adverse perinatal outcomes. Pathologic skin dermatoses and diseases of pregnancy are rare and have different presentations, treatment and prognoses. This literature review includes an up to date comparison on the presentation, diagnosis and treatment of dermatoses in pregnancy, in order to help with the discrimination. A case of pemphigoid gestationis in a 15 year old woman is described. This is the youngest reported age of presentation of pemphigoid gestationis, raising the question of whether maternal age is a factor that can affect the course and the severity of the disease.},
 year = {2019}
}

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TY  - JOUR
T1  - Pemphigoid Gestationis in a 15 Year Old Pregnant Patient, A Case Report and Literature Review
AU  - Emile Dabaj
AU  - Jana Abdo
AU  - Stephanie Yacoub
AU  - Rawad Halimeh
AU  - Zarouhie Bedoyan
AU  - Joe Khalifeh
Y1  - 2019/05/08
PY  - 2019
N1  - https://doi.org/10.11648/j.jgo.20190702.14
DO  - 10.11648/j.jgo.20190702.14
T2  - Journal of Gynecology and Obstetrics
JF  - Journal of Gynecology and Obstetrics
JO  - Journal of Gynecology and Obstetrics
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PB  - Science Publishing Group
SN  - 2376-7820
UR  - https://doi.org/10.11648/j.jgo.20190702.14
AB  - Pemphigoid gestationis, previously known as herpes gestationis, is a rare autoimmune bullous disease that manifests in pregnancy. Upon presentation, patients complain of intense pruritis, urticarial plaques, vesicles and bullae that primarily affect the peri-umbilical area before spreading to involve the rest of the body. The accurate diagnosis of pemphigoid gestationis is made histopathologically on biopsies, based on the presence of sub-epidermal vesicles, as well as direct visualization of linear deposition of C3 at the basement membrane zone by using immunofluorescence staining on those biopsies. The mainstay treatment of the disease remains corticosteroids. Prompt recognition and provision of the appropriate management allow a reduction in both maternal morbidity as well as fetal adverse perinatal outcomes. Pathologic skin dermatoses and diseases of pregnancy are rare and have different presentations, treatment and prognoses. This literature review includes an up to date comparison on the presentation, diagnosis and treatment of dermatoses in pregnancy, in order to help with the discrimination. A case of pemphigoid gestationis in a 15 year old woman is described. This is the youngest reported age of presentation of pemphigoid gestationis, raising the question of whether maternal age is a factor that can affect the course and the severity of the disease.
VL  - 7
IS  - 2
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Author Information

Emile Dabaj

Department of Obstetrics and Gynecology, St George Hospital University Medical Center, University of Balamand, Beirut, Lebanon
Jana Abdo

Department of Obstetrics and Gynecology, St George Hospital University Medical Center, University of Balamand, Beirut, Lebanon
Stephanie Yacoub

Department of Obstetrics and Gynecology, St George Hospital University Medical Center, University of Balamand, Beirut, Lebanon
Rawad Halimeh

Department of Obstetrics and Gynecology, St George Hospital University Medical Center, University of Balamand, Beirut, Lebanon
Zarouhie Bedoyan

Department of Pathology, St George Hospital University Medical Center, University of Balamand, Beirut, Lebanon
Joe Khalifeh

Department of Obstetrics and Gynecology, St George Hospital University Medical Center, University of Balamand, Beirut, Lebanon

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APA Style

Emile Dabaj, Jana Abdo, Stephanie Yacoub, Rawad Halimeh, Zarouhie Bedoyan, et al. (2019). Pemphigoid Gestationis in a 15 Year Old Pregnant Patient, A Case Report and Literature Review. Journal of Gynecology and Obstetrics, 7(2), 46-50. https://doi.org/10.11648/j.jgo.20190702.14

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ACS Style

Emile Dabaj; Jana Abdo; Stephanie Yacoub; Rawad Halimeh; Zarouhie Bedoyan, et al. Pemphigoid Gestationis in a 15 Year Old Pregnant Patient, A Case Report and Literature Review. J. Gynecol. Obstet. 2019, 7(2), 46-50. doi: 10.11648/j.jgo.20190702.14

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AMA Style

Emile Dabaj, Jana Abdo, Stephanie Yacoub, Rawad Halimeh, Zarouhie Bedoyan, et al. Pemphigoid Gestationis in a 15 Year Old Pregnant Patient, A Case Report and Literature Review. J Gynecol Obstet. 2019;7(2):46-50. doi: 10.11648/j.jgo.20190702.14

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@article{10.11648/j.jgo.20190702.14,
  author = {Emile Dabaj and Jana Abdo and Stephanie Yacoub and Rawad Halimeh and Zarouhie Bedoyan and Joe Khalifeh},
  title = {Pemphigoid Gestationis in a 15 Year Old Pregnant Patient, A Case Report and Literature Review},
  journal = {Journal of Gynecology and Obstetrics},
  volume = {7},
  number = {2},
  pages = {46-50},
  doi = {10.11648/j.jgo.20190702.14},
  url = {https://doi.org/10.11648/j.jgo.20190702.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jgo.20190702.14},
  abstract = {Pemphigoid gestationis, previously known as herpes gestationis, is a rare autoimmune bullous disease that manifests in pregnancy. Upon presentation, patients complain of intense pruritis, urticarial plaques, vesicles and bullae that primarily affect the peri-umbilical area before spreading to involve the rest of the body. The accurate diagnosis of pemphigoid gestationis is made histopathologically on biopsies, based on the presence of sub-epidermal vesicles, as well as direct visualization of linear deposition of C3 at the basement membrane zone by using immunofluorescence staining on those biopsies. The mainstay treatment of the disease remains corticosteroids. Prompt recognition and provision of the appropriate management allow a reduction in both maternal morbidity as well as fetal adverse perinatal outcomes. Pathologic skin dermatoses and diseases of pregnancy are rare and have different presentations, treatment and prognoses. This literature review includes an up to date comparison on the presentation, diagnosis and treatment of dermatoses in pregnancy, in order to help with the discrimination. A case of pemphigoid gestationis in a 15 year old woman is described. This is the youngest reported age of presentation of pemphigoid gestationis, raising the question of whether maternal age is a factor that can affect the course and the severity of the disease.},
 year = {2019}
}

Copy | Download

TY  - JOUR
T1  - Pemphigoid Gestationis in a 15 Year Old Pregnant Patient, A Case Report and Literature Review
AU  - Emile Dabaj
AU  - Jana Abdo
AU  - Stephanie Yacoub
AU  - Rawad Halimeh
AU  - Zarouhie Bedoyan
AU  - Joe Khalifeh
Y1  - 2019/05/08
PY  - 2019
N1  - https://doi.org/10.11648/j.jgo.20190702.14
DO  - 10.11648/j.jgo.20190702.14
T2  - Journal of Gynecology and Obstetrics
JF  - Journal of Gynecology and Obstetrics
JO  - Journal of Gynecology and Obstetrics
SP  - 46
EP  - 50
PB  - Science Publishing Group
SN  - 2376-7820
UR  - https://doi.org/10.11648/j.jgo.20190702.14
AB  - Pemphigoid gestationis, previously known as herpes gestationis, is a rare autoimmune bullous disease that manifests in pregnancy. Upon presentation, patients complain of intense pruritis, urticarial plaques, vesicles and bullae that primarily affect the peri-umbilical area before spreading to involve the rest of the body. The accurate diagnosis of pemphigoid gestationis is made histopathologically on biopsies, based on the presence of sub-epidermal vesicles, as well as direct visualization of linear deposition of C3 at the basement membrane zone by using immunofluorescence staining on those biopsies. The mainstay treatment of the disease remains corticosteroids. Prompt recognition and provision of the appropriate management allow a reduction in both maternal morbidity as well as fetal adverse perinatal outcomes. Pathologic skin dermatoses and diseases of pregnancy are rare and have different presentations, treatment and prognoses. This literature review includes an up to date comparison on the presentation, diagnosis and treatment of dermatoses in pregnancy, in order to help with the discrimination. A case of pemphigoid gestationis in a 15 year old woman is described. This is the youngest reported age of presentation of pemphigoid gestationis, raising the question of whether maternal age is a factor that can affect the course and the severity of the disease.
VL  - 7
IS  - 2
ER  -

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