Pemphigoid gestationis

Abstract

Pemphigoid gestationis (PG) is an autoimmune blistering disease that occurs during pregnancy or soon after delivery. It is possibly caused by crossreactivity between placental antigens and collagen XVII in the skin. Patients typically present with an intensely pruritic, vesiculobullous rash that starts periumbilically and spreads outwards across the trunk and extremities. Treatment is with immunosuppressive agents; however, given that PG is very rare-estimated to occur in 1 in 50,000 pregnancies-there is a paucity of evidence around specific treatments. Treatment of PG is also complicated by the need to consider the health of the fetus. Often, evidence for the use of immunosuppressant medications in pregnant women for other diseases can be extrapolated to PG. We review the literature and present an algorithm for treatment in the pre- and post-partum periods for women with PG based on the evidence available. We also list areas of focus for the future.