Gestational pemphigoid

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Gestational pemphigoid: a simple guide

What is it
Gestational pemphigoid (GP) is a rare autoimmune skin condition that starts during pregnancy. It is a form of bullous pemphigoid and is not caused by a viral infection.

Symptoms
- Itchy, tense blisters and a blistering rash
- Usually begins around the navel and may spread to other parts of the body
- The face and mouth are usually not affected
- The itching can be very intense

When it occurs
- Most often in the middle of pregnancy or shortly after delivery
- It can flare after birth and may come back in future pregnancies or around menstrual periods or with certain birth control pills

Causes
- GP is an autoimmune reaction. The body makes antibodies that attack a skin protein at the junction between skin layers
- The placenta may be involved in the immune reaction
- Triggers include pregnancy; in some people, GP recurs with later pregnancies

Risks to the baby
- The pregnancy can be high-risk for certain outcomes such as preterm birth or a smaller baby
- About 10% of newborns may have mild skin lesions due to antibodies, but these usually resolve after birth

Diagnosis
- Based on the appearance of the rash
- Confirmed with skin biopsy and immunofluorescence tests

Treatment
- The main treatment is corticosteroids, either oral (like prednisone) or a topical steroid
- In some cases, other immune-suppressing therapies may be used, especially after birth if symptoms are severe
- There is no cure, but GP often goes into remission after delivery or with effective treatment

Prognosis
- Many people improve after delivery
- GP can recur in future pregnancies, but management helps make outcomes better

How common
- Affects about 1 in 20,000 to 50,000 pregnancies

Important notes
- GP was once called herpes gestationis, but it is not caused by herpes
- If you develop a blistering rash during pregnancy, seek medical care to get the right diagnosis and treatment