Herpes Gestationis - Symptoms & Treatment
Herpes gestationis is a rare autoimmune bullous dermatosis of pregnancy. It is most common during the second and third trimesters of pregnancy. It is also known as pemphigoid gestationis although it has no association with the herpes virus whatsoever. It is an autoimmune blistering disease, which basically means that an individual's immune system starts reacting against his or her own tissue. The trigger for the development of autoantibodies in persons with PG remains elusive. Cross-reactivity between placental tissue and skin has been proposed to play a role. Herpes gestationis begins with very itchy, red hives or small bumps around the belly button. Within days to weeks, the rash spreads, and the hives and bumps join to form bizarrely shaped circular patches that cover a wide area of skin. The rash usually worsens during labor or immediately postpartum (in 75%), typically remitting within a few weeks or months. Some pregnant women find that their palms and the soles of their feet get red and sometimes itchy. This common condition may be caused by an increase in estrogen.
Herpes gestationis may recur with the resumption of menses, use of oral contraception, and subsequent pregnancies. In pemphigoid gestationis the target is a protein known as BPAG2 (also called BP180), found within the basement membrane, which is the zone between the epidermis and the dermis. Pemphigoid gestationis can come and go throughout pregnancy, and it often flares up after delivery as well. It usually happens again in subsequent pregnancies and tends to be more severe. PG has also been described to occur in association with trophoblastic tumors, such as hydatiform mole or choriocarcinoma. Within days to weeks, the rash spreads to other parts of the body including the trunk, back, buttock, and arms. The face, scalp, palms, soles and mucous membranes are usually not affected. Pemphigoid gestationis is diagnosed by taking skin biopsies of different areas of the rash and normal-appearing skin. Pemphigoid gestationis is confirmed by direct immunofluorescence staining of the biopsy to reveal antibodies.
Causes of Herpes gestationis
The common causes and risk factor's of Herpes gestationis include the following:
- The cause of pemphigoid gestationis is autoimmune.
- It is most common during the second and third trimesters of pregnancy.
- Immunoglobulin type G (IgG) autoantibodies (known as the PG factor).
Symptoms of Herpes gestationis
Some sign and symptoms related to Herpes gestationis are as follows:
- Initially there are itchy red bumps around the belly button.
- Vesicular rash.
- Some patients may have no blisters but instead have plaques (large raised patches).
- Papular rash.
- Lesions often start on the abdomen, then become widespread.
- The rash usually worsens during labor or immediately postpartum (in 75%), typically remitting within a few weeks or months.
Treatment of Herpes gestationis
Here is list of the methods for treating Herpes gestationis:
- A few women with very mild cases of pemphigoid gestationis can be treated with steroid creams and antihistamines.
- Prednisone relieves moderate or severe pruritus and prevents new lesions; dose is tapered until few new lesions erupt, but it may need to be increased if symptoms become more severe.
- Topical corticosteroids are used in mild disease whilst oral corticosteroids are necessary in more extensive cases.
- Oral antihistamines may be used to relieve itching.
- Pyridoxine has also been reported to be effective.