Gestational pemphigoid

Gestational pemphigoidGestational pemphigoid is an autoimmune dermatosis of pregnancy. It was originally named because of the characteristic features of gestational herpes herpetiform of vesicles, but the term is a misnomer because the condition is not associated with active viral herpetic infection or a history.
The disease does not cause fetal growth or maternal mortality. It is associated with an increased prevalence of premature babies and small gestational age. 5-10% of all babies may resolve transitional skin damage as maternal antibodies disappear. Patients with gestational pemphigoid have an increased prevalence of autoimmune diseases, including Hashimoto's thyroiditis, pernicious anemia and Graves' disease, also associated with HLA-DR3 haplotype-4.The disease manifests during the third quarter of pregnancy by urticarial rash, pruritic papular on the abdomen and torso. Including persistent disease has been reported for several years after birth.
Treatment aims relieve itching and blocked vesicle enlargement. It shows warm baths and compresses to relieve itching, antihistamines and corticosteroids. It will use first the lowest therapeutic dose because the mother's pregnancy status. If they do not opt for the efficient drugs are more powerful. Gestational pemphigoid regresses in a few weeks or months after delivrenta without scars. May return during other tasks, may be precipitated by menstruation or oral contraceptives.
Pathogenesis and causes
Gestational pemphigoid is an autoimmune disease associated with pregnancy. Most patients develop antibodies against two proteins hemidesmosomale. Known as herpes factor gestational gestational these antibodies belong to immunoglobulin class G1 heat. This triggers an autoimmune response leading to vesicle formation subepidermice. Trigger disease still remains unidentified. He proposed an activation reaction cross between placental tissue and skin. Gestational pemphigoid is closely linked to the haplotype HLA-DR3-4. Placenta is known to be the main source of antibodies and so parents can be a target immune during pregnancy.
Signs and symptoms
Gestational pemphigoid occurs in pregnant women. It typically manifests in advanced pregnancy with sudden onset of pruritic urticarial papules and vesicles on the abdomen and torso. Itching can be so severe, that you can interrupt daily activities. Injuries can occur anytime during pregnancy, but developed mainly during the second and third quarter. Symptoms may occur in pregnancy but also sfirsutul immediate delivery. Gestational pemphigoid usually resolves spontaneously within a few weeks or months after delivrenta even earlier if the nursing breast. The persistence of disease activity is described even after a few years after birth. The disease can be triggered by the use of contraceptives and menstrual periods, and the tasks ahead.
Physical examination.Initial clinical manifestations are typical erythematous patches and urticarial periombilicale boards. These lesions progress to vesicles energized. Some patients may experience only pleasure without veziculizare urticarial. The rash expands peripherally, avoiding the face, palms and soles. Mucosal lesions occur in 20% of cases. Patients may develop secondary infections at veziculizarii.
Diagnosis
Routine laboratory tests are not helpful in diagnosing the disease. Blood results are normal, although peripheral eosinophilia is observed. Tests also showed increased immunoglobulins, erythrocyte sedimentation rate, acute phase reactants and antithyroid antibodies. HLA-DR haplotype 3-4 is present in 45% of cases.Histological examination.Prelevatele affected skin biopsy showed infiltration with predominantly eosinophilic veziculizare subepidermica. The inflammatory infiltrate is located at the dermo-epidermal junction and perivascular. Keratinocyte necrosis and dermal edema are often present.The differential diagnosis is made with the following disorders: bullous pemphigoid, pemphigoid scar, linear IgA dermatosis, acute urticaria, contact dermatitis, dermatitis herpetiformis, erythema multiforme, bullous diseases induced by drugs, papular dermatitis of pregnancy, pruritic folliculitis of pregnancy.
Treatment
Treatment tries to relieve itching and peripheral extension of the eruption. To minimize the risk to the fetus and mother are used therapeutically to lower levels of disease suppression. Assessed the risks and benefits must always tried terapeiilor.
Medical therapy.It shows warm baths, and compresses to relieve itching emolientele. Patients with mild can be treated with antihistamines and topical or intralesional steroids like triamcinolone. However, these regimens are usually ineffective in severe cases, making the necessary systemic corticosteroids: prednisone. Once veziculizarea stopped and the lesions begin to heal until the dose of prednisone is decreased to the minimum that controls the disease. Other regimens include azathioprine, pyridoxine, plasmapheresis, dapsone, intravenous immunoglobulin, cyclosporine and minocycline / nicotinamide. It is promising and chemical oophorectomy with goserelin.
Prognosis
Women with gestational pemphigoid delivrentei have a higher incidence of premature and newborn babies in the optimal gestational age. It has been observed and a risk of immunological diseases. Children born out of a mother with the disease may be rarely veziculizare. They are however at risk of infection, and thermoregulatory disorders of fluid and electrolyte balance. Pemphigoid regresses in a few weeks or months after delivery. May return to other tasks and can be precipitated by menstruation or oral contraceptives. Impaired skin of newborn babies is rare and decreases with the disappearance of maternal antibodies.